Long-term clinical outcome in the bypass angioplasty revascularization investigation registry comparison with the randomized trial

Background-The Bypass Angioplasty Revascularization Investigation (BARI) in cluded 4039 patients with multivessel coronary artery disease; 1829 consent ed to randomization, and 2010 did not but were followed up in a registry. T hus, we can evaluate the outcome of physician-guided versus random assignme nt of percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass graft surgery (CABG). Methods and Results-We compared the baseline features and outcomes for PTCA and CABG in the overall registry and its predesignated subgroups. We asses sed the impact of treatment by choice versus random assignment by comparing the results in the registry with those of the randomized trial. Statistica l adjustments for differences in baseline characteristics were made. Within the registry, nearly twice as many patients were selected for PTCA (1184) as CABG (625); mortality at 7 years was similar for PTCA (13.9%) and CABG ( 14.2%) (P=0.66) before and after adjustment for baseline differences betwee n patients selected for PTCA versus CABG(adjusted RR, 1.02; P=0.86). In con trast to the randomized trial, the 7-year mortality rate of treated diabeti cs in the registry was equally high (26%) with PTCA or CABG. Seven-year mor tality was higher for patients undergoing PTCA in the randomized trial than in the registry (19.1% versus 13.9%, P<0.01) but not for those undergoing CABG (15.6% versus 14.2%, P=0.57). The adjusted relative mortality risk for PTCA in the randomized versus registry population was 1.17 (P=0.16), Conclusions-BARI physicians were able to select PTCA rather than CABG for 6 5% of registry patients who underwent revascularization without compromisin g long-term survival either in the overall population or in treated diabeti cs.