A comparison of three-year survival after coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty

Objectives. The purpose of this study was to compare 3-year risk-adjusted s urvival in patients undergoing coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty, Background. Coronary artery bypass graft surgery and angio plasty are he co mmon treatments for coronary artery disease. For referral purposes, it is i mportant to know the relative pattern of survival after hospital discharge for these procedures and to identify patient characteristics that are relat ed to survival, Methods. New York's CABG surgery and angioplasty registries were used to id entify New York patients undergoing CABG surgery and angioplasty from Janua ry 1, 1993 to December 31, 1995, Mortality within 3 years of undergoing the procedure (adjusted for patient severity of illness) and subsequent revasc ularization within 3 years were captured. Three year mortality rates were a djusted using proportional hazards methods to account for baseline differen ces in patients' severity of illness. Results. Patients with one-vessel disease with the one vessel not involving the left anterior descending artery (LAD) or with less than 70% LAD stenos is had a statistically significantly longer adjusted 3-year survival with a ngioplasty (95.3%) than with CABG surgery (92.4%). Patients with proximal L AD stenosis of at least 70% had a statistically significantly longer adjust ed 3-year survival with CABG surgery than with angioplasty regardless of th e number of coronary vessels diseased, Also, patients with three-vessel dis ease had a statistically significantly longer adjusted 3-year survival with CABG surgery regardless of proximal LAD disease. Patients with other one-v essel or he-vessel disease had no treatment-related differences in survival . Conclusions. Treatment-related survival benefit at 3-years in patients with ischemic heart disease is predicted by the anatomic extent and specific si te of the disease, as well as by the treatment chosen. (C) 1998 by the Amer ican College of Cardiology.