Relation between coronary artery disease, baseline clinical variables, revascularization mode, and mortality

The Coronary Angioplasty vs. Bypass Revascularisation Investigation (CABRI) trial comparing percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass grafting did not show a difference in mortality wit h either procedure, Nonrandomized studies suggest that coronary artery dise ase (CAD) severity and distribution influences outcome. In the present stud y we explored the effect of prerevascularization CAD on I-year mortality in the CABRI population, while adjusting for other baseline variables. Of the 1,054 patients recruited, there were sufficient angiographic results to de rive the CAD scores in 974 (92.4%), Of these 974, there were 32 deaths. A n umber of CAD scores, both weighted for proximal disease (Duke and Leaman) a nd nonweighted, were used. These scores were then cross-tabulated against m ortality. Demographic and clinical variables were also cross-tabulated agai nst mortality and used to derive an initial logistic regression model to pr edict mortality. The effect of adding each of the CAD scores to this initia l model was then assessed, After inclusion of the CAD scores, the best mode l was: (1) presence of peripheral vascular disease (odds ratio [OR] 3.89, p = 0.0025), (2) previous cerebrovascular accident (OR 2.86, p = 0.043), (3) older age (OR 1.05, p = 0.039), (4) a higher Duke score (OR 2.84, p = 0.00 61), and (5) having undergone PTCA (OR 2.12, p = 0.047). In the CABRI popul ation, adjustment for baseline variables, including prerevascularization CA D, revealed significantly higher mortality in those who underwent PTCA than in those who underwent coronary artery bypass grafting. (C)2000 by Excerpt a Medica, Inc.