Predictors of mortality and mortality from cardiac causes in the bypass angioplasty revascularization investigation (BARI) randomized trial and registry

Background-The impact of percutaneous transluminal coronary angioplasty (PT CA) and coronary artery bypass grafting (CABG) on long-term mortality rates in the presence of various demographic, clinical, and angiographic factors is uncertain in the population of patients suitable for both procedures. Methods and Results-In the Bypass Angioplasty Revascularization Investigati on (BARI) randomized trial and registry, 3610 patients who were eligible to receive PTCA and CABG were revascularized between 1989 and 1993. Multivari ate Cox models were used to identify factors associated with 5-year mortali ty and cardiac mortality, with particular attention to factors that interac t with treatment. Diabetic patients receiving insulin had higher mortality and cardiac mortality rates with PTCA compared with CABG (relative risk [RR ] 1.78 and 2.63, respectively, P<0.001), and patients with ST elevation had higher cardiac mortality rates with CABG than with PTCA (RR 4.08, P<0.001) . Factors most strongly associated with high overall mortality rates were i nsulin-treated diabetes, congestive heart failure, kidney failure, and olde r age. Black race was also associated with higher mortality rates (RR 1.49, P=0.19). Conclusions-A set of variables was identified that could be used to help se lect a revascularization procedure and to evaluate risk of long-term mortal ity in the population of patients considering revascularization.