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The design, patient population and outcomes from the Bypass Angioplasty Revascularization Investigation (BARI)

M M Brooks1, K M Detre

  • 1The Epidemiology Data Center, University of Pittsburgh, PA 15261, USA.

Seminars in Interventional Cardiology : SIIC
|March 30, 2000
PubMed

Insights

Coronary artery bypass grafting (CABG) significantly improved 7-year survival in diabetic patients compared to percutaneous transluminal coronary angioplasty (PTCA). No survival difference was found between CABG and PTCA in non-diabetic patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Symptomatic multivessel coronary artery disease requires effective revascularization strategies.
  • Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are primary treatment options.
  • The Bypass Angioplasty Revascularization Investigation (BARI) aimed to compare these interventions.

Purpose of the Study:

  • To compare the long-term efficacy of CABG versus PTCA in patients with multivessel coronary artery disease.
  • To specifically evaluate treatment outcomes based on diabetic status.

Main Methods:

  • A randomized trial comparing CABG and PTCA.
  • Follow-up of 7-year survival and clinical events.
  • Subgroup analysis of patients with and without diabetes mellitus.

Main Results:

  • Overall 7-year survival favoured CABG.
  • In patients with diabetes mellitus, CABG showed an overwhelming survival benefit (23.6% vs 44.3% mortality, p=0.0011).
  • No significant difference in survival was observed for non-diabetic patients (13.6% vs 13.2%, p=0.72).
  • PTCA patients had fewer in-hospital Q-wave MIs but more repeat revascularizations and angina.

Conclusions:

  • CABG offers a significant survival advantage over PTCA for diabetic patients with multivessel coronary artery disease.
  • Treatment choice between CABG and PTCA should consider diabetic status.
  • Further research may explore mechanisms behind the differential treatment effect.

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