METAANALYSIS OF RANDOMIZED TRIALS COMPARING CORONARY ANGIOPLASTY WITHBYPASS-SURGERY

A patient with severe angina will often be eligible for either angiopl asty (PTCA) or bypass surgery (CABG). Results from eight published ran domised trials have been combined in a collaborative meta-analysis of 3371 patients (1661 CABG, 1710 PTCA) with a mean follow-up of 2 . 7 ye ars. The total deaths in the CABG and PTCA groups were 73 and 79, resp ectively, with a relative risk (RR) of 1 . 08 (95% CI 0 . 79-1 . 50). The combined endpoint of cardiac death and non-fatal myocardial infarc tion occurred in 169 PTCA patients and 154 CABG patients (RR 1 . 10 [0 . 89-1 . 37]). Amongst patients randomised to PTCA 17 . 8% required a dditional CABG within a year, while in subsequent years the need for a dditional CABG was around 2% per annum. The rate of additional non-ran domised interventions (PTCA and/or CABG) in the first year of follow-u p was 33 . 7% and 3 . 3% in patients randomised to PTCA and CABG, resp ectively. The prevalence of angina after one year was considerably hig her in the PTCA group (RR 1 . 56 [1 . 30-1 . 88]) but at 3 years this difference had attenuated (RR 1 . 22 [0 . 99-1 . 54]). Overall there w as substantial similarity in outcome across the trials. Separate analy ses for the 732 single-vessel and 2639 multivessel disease patients we re largely compatible, though the rates of mortality, additional inter vention, and prevalent angina were slightly lower in single vessel dis ease. The combined evidence comparing PTCA with CABG shows no differen ce in prognosis between these two initial revascularisation strategies . However, the treatments differ markedly in the subsequent requiremen t for additional revascularisation procedures and in the relief of ang ina. These results will influence the choice of revascularisation proc edure in future patients with angina.