A RANDOMIZED TRIAL COMPARING CORONARY ANGIOPLASTY WITH CORONARY-BYPASS SURGERY

Background. The clinical benefit of percutaneous transluminal coronary angioplasty (PTCA) as compared with coronary-artery bypass grafting ( CABG) for patients with multivessel coronary artery disease has not be en established. To determine the outcomes of these treatments in patie nts referred for the first time for coronary revascularization, we con ducted a three-year prospective, randomized trial comparing the two pr ocedures. Methods. Revascularization was performed by accepted methods . Follow-up clinical information was collected every six months, and c oronary arteriography and thallium stress scanning were performed at o ne and three years. The primary end point was a composite of death, Q- wave myocardial infarction, and a large ischemic defect identified on thallium scanning at three years. Secondary end points included clinic al and angiographic status and the need for additional revascularizati on procedures. Data were analyzed according to the intention-to-treat principle. Results. Of the 5118 patients screened for the trial, 842 ( 16.5 percent) were eligible for enrollment, and 392 (7.7 percent) agre ed to participate. A total of 194 patients were randomly assigned to t he CABG group, and 198 to the PTCA group. The primary end point occurr ed in 27.3 percent of the CABG group and 28.8 percent of the PICA grou p (P = 0.81). Death occurred in 6.2 percent of the CABG group and 7.1 percent of the PTCA group (P = 0.73 by log-rank test). At three years, the proportions of patients in the CABG group who required repeated b ypass surgery (1 percent) or angioplasty (13 percent) were significant ly lower than the proportions in the PTCA group (22 and 41 percent, re spectively; P<0.001). Angiographic studies at three years showed a gre ater degree of revascularization in the CABG group. Angina was more fr equent in the PTCA group (20 percent) than in the CABG group (12 perce nt). Conclusions. We found that CABG and PTCA did not differ significa ntly with respect to the occurrence of the composite primary end point . Consequently, the selection of one procedure over the other should b e guided by patients' preferences regarding the quality of life and th e possible need for subsequent procedures.