Is a strategy of intended incomplete percutaneous transluminal coronary angioplasty revascularization acceptable in nondiabetic patients who are candidates for coronary artery bypass graft surgery? The Bypass Angioplasty Revascularization Investigation (BARI)

OBJECTIVES Our objective was to determine whether a strategy of intended in complete percutaneous transluminal coronary angioplasty revascularization ( IR) compromises long-term patient outcome. BACKGROUND Complete angioplasty revascularization (CR) is often not planned nor attempted in patients with multivessel coronary disease, and the exten t to which this influences outcome is unclear. METHODS Before randomization, in the Bypass Angioplasty Revascularization I nvestigation, all angiograms were assessed for intended CR or IR via angiop lasty. Outcomes were compared among patients with IR intended if assigned t o angioplasty, randomized to coronary artery bypass graft surgery (CABG) ve rsus angioplasty; and within angioplasty patients only, among patients with IR versus CR intended. RESULTS At 5 years, there was a trend for higher overall (88.6% vs. 84.0%) and cardiac survival (94.5% vs. 92.1%) in CABG versus angioplasty patients with IR intended. The excess mortality in angioplasty patients occurred sol ely in diabetic subjects; overall and cardiac survival were similar among n ondiabetic CABG and angioplasty patients. Freedom from myocardial infarctio n (MI) at 5 years was higher in nondiabetic CABG versus angioplasty patient s (92.4% vs. 85.2%, p = 0.02), yet was similar to the rate observed (85%) i n nondiabetic CABG and angioplasty patients with CR intended. Five-year rat es of death, cardiac death, repeat revascularization and angina were simila r in all angioplasty patients with IR versus CR intended. However, a trend for greater freedom from subsequent CABG was seen in CR patients (70.3% vs. 64.0%, p = 0.08). CONCLUSIONS Intended incomplete angioplasty revascularization in nondiabeti c patients with multivessel disease who are candidates for both angioplasty and CABG does not compromise long-term survival; however, subsequent need for CABG may be increased with this strategy. Whether the risk of long-term MI is also increased remains uncertain. (C) 1999 by the American College o f Cardiology.