Survival following coronary angioplasty versus coronary artery bypass surgery in anatomic subsets in which coronary artery bypass surgery improves survival compared with medical therapy - Results from the Bypass Angioplasty Revascularization Investigation (BARI)

OBJECTIVES We sought to compare survival after coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) in high-r isk anatomic subsets. BACKGROUND Compared with medical therapy, CABG decreases mortality in patie nts with three-vessel disease and two-vessel disease involving the proximal left anterior descending artery (LAD), particularly if left ventricular (L V) dysfunction is present. flow survival after PTCA and CABG compares in th ese high-risk anatomic subsets is unknown. METHODS In the Bypass Angioplasty Revascularization Investigation (BARI), 1 ,829 patients with multivessel disease were randomized to an initial strate gy of PTCA or CABG between 1988 and 1991. Stents and IIb/IIIa inhibitors we re not utilized. Since patients in BARI with diabetes mellitus had greater survival with CABG, separate analyses of patients without diabetes were per formed. RESULTS Seven-year survival among patients with three-vessel disease underg oing PTCA and CABG (n = 754) was 79% versus 84% (p = 0.06), respectively, a nd 85% versus 87% (p = 0.36) when only non-diabetics (n = 592) were analyze d. In patients with three-vessel disease and reduced LV function (ejection fraction <50%), seven-year survival was 70% versus 74% (p = 0.6) in an PTCA and CABG patients (n = 176), and 82% versus 73% (p = 0.29) among non-diabe tic patients (n = 124). Seven-year survival was 87% versus 84% (p = 0.9) in an PTCA and CABG patients (including diabetics) with two-vessel disease in volving the proximal LAD (n = 352), and 78% versus 71% (p = 0.7) in patient s with two-vessel disease involving the proximal LAD with reduced LV functi on (n = 72). CONCLUSION In high-risk anatomic subsets in which survival is prolonged by CABG versus medical therapy, revascularization by PTCA and CABG yielded equ ivalent survival over seven years. (J Am Coll Cardiol 2001;38:1440-9) (C) 2 001 by the American College of Cardiology.