A RANDOMIZED STUDY OF CORONARY ANGIOPLASTY COMPARED WITH BYPASS-SURGERY IN PATIENTS WITH SYMPTOMATIC MULTIVESSEL CORONARY-DISEASE

Background. The standard treatment for patients with symptomatic multi vessel coronary artery disease is coronary-artery bypass grafting (CAB G). Percutaneous transluminal coronary angioplasty (PTCA) is widely us ed as an alternative approach to revascularization, but a systematic c omparison of the two procedures is needed. We compared the outcomes in patients one year after complete revascularization with CABG or PTCA. Methods. A total of 8981 patients with multivessel coronary disease w ere screened at eight clinical sites, and 359 patients were randomly a ssigned to undergo CABG (177 patients) or PTCA (182 patients). Enrollm ent required that complete revascularization of at least two major ves sels supplying different myocardial regions be deemed clinically neces sary and technically feasible. Results. Among the patients in the CABG group, an average (+/-SD) of 2.2+/-0.6 vessels were grafted, and amon g those in the PTCA group, 1.9+/-0.5 vessels were dilated. After CABG, hospitalization was longer (median, 19 days, as compared with 5 for P TCA), and Q-wave myocardial infarction in relation to the procedure wa s more frequent (8.1 percent, as compared with 2.3 percent after PTCA; P = 0.022), whereas in-hospital mortality did not differ significantl y between the two groups (2.5 percent in the CABG group and 1.1 percen t in the PTCA group). At discharge 93 percent of the patients in the C ABG group were free of angina, as compared with 82 percent of those in the PTCA group (P = 0.005). During the first year of follow-up, furth er interventions were necessary in 44 percent of the patients in the P TCA group (repeated PTCA in 23 percent, CABG in 18 percent, and both i n 3 percent) but in only 6 percent of the patients in the CABG group ( repeated CABG in 1 percent and PTCA in 5 percent; P<0.001). Seventy-fo ur percent of the patients in the CABG group and 71 percent of those i n the PTCA group were free of angina one year after treatment. Exercis e capacity improved similarly in both groups. However, 22 percent of t he CABG group, as compared with only 12 percent of the PTCA group, did not require antianginal medication (P = 0.041). Conclusions. In selec ted patients with multivessel coronary disease, PTCA and CABG as initi al treatments resulted in equivalent improvement in angina after one y ear. However, in order to achieve similar clinical outcomes, the patie nts treated with PTCA were more likely to require further intervention s and antianginal drugs, whereas the patients treated with CABG were m ore likely to sustain an acute myocardial infarction at the time of th e procedure.