ANGIOPLASTY OR SURGERY FOR MULTIVESSEL CORONARY-ARTERY DISEASE - COMPARISON OF ELIGIBLE REGISTRY AND RANDOMIZED PATIENTS IN THE EAST TRIAL AND INFLUENCE OF TREATMENT SELECTION ON OUTCOMES

The Emery Angioplasty versus Surgery Trial (EAST) showed that multives sel patients eligible for both percutaneous transluminal coronary angi oplasty (PTCA) and coronary bypass surgery (CABG) had equivalent 3-yea r outcomes regarding survival, myocardial infarction, and major myocar dial ischemia. Patients eligible for the trial who were not randomized because of physician or patient refusal were followed in a registry. This study compares the outcomes of the randomized and registry patien ts. Of the 842 eligible patients, 450 did not enter the trial. Their b aseline features closely resembled those of the randomized patients an d follow up was performed using the same methods. In the registry ther e was a bias toward selecting CABG in patients with 3-vessel disease ( 84%) and PTCA in patients with 2-vessel disease (54%). Three-year surv ival for the registry patients was 96.4%, which was better than the ra ndomized patients, 93.4% (p = 0.044). Angina relief in the registry wa s equal for CABG and PTCA patients and was better for the PTCA registr y (12.4%) than PTCA randomized patients (19.6%) (p = 0.079). Thus, the registry confirms that EAST is representative of all eligible patient s and does not represent a low-risk subgroup. Since baseline differenc es were small, improved survival in the registry may be due to treatme nt selection. Physician judgment, even in patients judged appropriate for clinical trials, remains a potentially important predictor of outc omes. (C) 1997 by Excerpta Medico, Inc.