Relationship of extent of revascularization with angina at one year in theBypass Angioplasty Revascularization Investigation (BARI)

OBJECTIVES To determine the relative degree of revascularization obtained w ith bypass surgery versus angioplasty in a randomized trial of patients wit h multivessel disease requiring revascularization (Bypass Angioplasty Revas cularization Investigation [BARI]), one-year catheterization was performed in 15% of patients. BACKGROUND Complete revascularization has been correlated with improved out come after coronary artery bypass grafting (CABG) but not with percutaneous transluminal coronary angioplasty (PTCA). Relative degrees of revasculariz ation after PTCA and surgery have not been previously compared and correlat ed with symptoms. METHODS Consecutive patients at four BART centers consented to recatheteriz ation one year after revascularization. Myocardial jeopardy index (MJI), th e percentage of myocardium jeopardized by greater than or equal to 50% sten oses, was compared and correlated with angina status. RESULTS Angiography was completed in 270 of 362 consecutive patients (75%) after initial CABG (n = 135) or PTCA (n = 135). Coronary artery bypass graf ting patients had 3 +/- 0.9 distal anastomoses and PTCA patients had 2.4 +/ - 1.1 lesions attempted at initial revascularization. At one year, 20.5% of CABG patients had greater than or equal to 1 totally occluded graft and 86 .9% of vein graft, and 91.6% of internal mammary artery distal anastomotic sites had <50%, stenosis. One year jeopardy index in surgery patients was 1 4.1 +/- 11%, 46.6 +/- 20.3% improved from baseline. Initial PTCA was succes sful in 86.9% of lesions and repeat revascularization tvas performed in 48. 4% of PTCA patients by one year. Myocardial jeopardy index one year after P TCA was 25.5 +/- 22.8%, an improvement of 33.8 +/- 26.1% (p < 0.01 for grea ter improvement with CABG than PTCA). At one year, 29.6%, of PTCA patients had angina versus 11.9% of surgery patients, p = 0.004. One-year myocardial jeopardy was predictive of angina (odds ratio 1.28 for the presence of ang ina per every 10%, increment in myocardial jeopardy, p = 0.002). Randomizat ion to PTCA rather than CABG also predicted angina (odds ratio 2.19, p = 0. 03). CONCLUSIONS In this one-year angiographic substudy of BARI, CABG provided m ore complete revascularization than PTCA, and CABG likewise improved angina to a greater extent than PTCA. (C) 1999 by the American College of Cardiol ogy.