Similarity of ventricular function in patients alive 5 years after randomization to surgery or angioplasty in the BARI trial

Background-Left ventricular ejection fraction (LVEF) is a recognized determ inant of survival in patients with coronary artery disease. In major trials comparing surgical and percutaneous revascularization approaches, the long -term effect of the coronary revascularization strategy on LVEF has not bee n reported, Methods and Results-In the NHLBI-sponsored Bypass and Angioplasty Revascula rization Investigation (BARI) randomized trial comparing angioplasty and by pass surgery as initial treatment strategies, 1220 (75%) of the 1617 surviv ing randomized patients had their EF measured by radionuclide ventriculogra phy 5 years after study entry, For the total study group, the 5-year EF in the CABG group (n=623) was 55.8+/-12.3, compared with 55.7+/-12.7 in PTCA g roup (n=597, P=0.82). There was no significant difference in measured EF be tween the CABG group and the PTCA group within multiple subgroups determine d by the presence or absence of diabetes, 3-vessel disease, complete revasc ularization, or prior myocardial infarction. In a multiple linear regressio n model developed to predict 5-year EF, treatment assignment to PTCA or CAB G was not significant (P=0.95). If an EF of 0 was imputed for patients who were dead and missing EF data, however, there was a higher EF in the CABG g roup (P=0.0018) among diabetic patients only. Conclusions-In the BARI randomized trial, initial treatment assignment to a ngioplasty was not associated with any difference in long-term ventricular function compared with initial treatment assignment to surgery. These resul ts apply, however, only to patients who were alive at 5 years.