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Long-term clinical outcome in the Bypass Angioplasty Revascularization Investigation Registry: comparison with the

F Feit1, M M Brooks, G Sopko

  • 1Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA. frederick.feit@nyu.med.edu

Circulation
|June 22, 2000
PubMed

Insights

Physician-guided percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass graft surgery (CABG) in the BARI registry showed similar long-term survival. This held true for overall patients and treated diabetics, demonstrating physician choice did not compromise outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials

Background:

  • The Bypass Angioplasty Revascularization Investigation (BARI) enrolled 4039 patients with multivessel coronary artery disease.
  • 1829 patients consented to randomization, while 2010 followed a physician-guided registry approach.
  • This design allows comparison of random assignment versus physician choice for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG).

Purpose of the Study:

  • To evaluate the long-term outcomes of physician-guided treatment selection versus random assignment for PTCA and CABG.
  • To compare the effectiveness of PTCA and CABG in patients with multivessel coronary artery disease within a registry setting.
  • To assess the impact of treatment choice on survival, particularly in diabetic patients.

Main Methods:

  • Comparison of baseline characteristics and 7-year outcomes between PTCA and CABG in the BARI registry and randomized trial.
  • Statistical adjustments were applied to account for differences in baseline patient characteristics.
  • Analysis focused on overall mortality and subgroup analyses, including treated diabetics.

Main Results:

  • In the registry, PTCA was selected more often than CABG (1189 vs. 625).
  • Seven-year mortality was similar for PTCA (13.9%) and CABG (14.2%) in the registry (P=0.66), even after adjustment.
  • Treated diabetics in the registry had equally high mortality (26%) with either PTCA or CABG; PTCA mortality was higher in the randomized trial than the registry (19.1% vs. 13.9%, P<0.01).

Conclusions:

  • BARI physicians successfully selected PTCA over CABG for 65% of registry patients undergoing revascularization.
  • Physician-guided treatment selection did not compromise long-term survival in the overall population or in treated diabetics.
  • The study supports the feasibility of physician-guided revascularization strategies without negatively impacting long-term patient survival.
Abstract

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