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Clinical trials of coronary revascularization: coronary angioplasty vs. coronary bypass grafting
1Research Center, Montreal Heart Institute, Quebec, Canada. bourassa@icm.umontreal.ca
Insights
For patients without diabetes, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) show similar long-term survival rates. PTCA requires more repeat procedures, while CABG costs diminish over time.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) management involves revascularization strategies like PTCA and CABG.
- Long-term comparative effectiveness data for these procedures in non-diabetic patients are crucial for clinical decision-making.
Purpose of the Study:
- To compare the long-term outcomes of percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass grafting (CABG) in non-diabetic patients with coronary artery disease.
- To evaluate survival, freedom from myocardial infarction (MI), need for additional revascularization, angina prevalence, and healthcare costs.
Main Methods:
- Long-term follow-up study comparing PTCA and CABG treatment groups.
- Analysis of survival, myocardial infarction rates, repeat revascularization procedures, angina symptoms, and healthcare costs.
Main Results:
- In multivessel disease, PTCA and CABG showed similar survival and freedom from MI at 6.5-8 years.
- PTCA patients required 2.5-4.5 times more additional revascularization than CABG patients.
- Angina prevalence and long-term costs were comparable between PTCA and CABG.
- In single vessel disease, survival free of MI was comparable at 5 years, with more repeat procedures after PTCA.
Conclusions:
- For non-diabetic patients with multivessel disease, the choice between PTCA and CABG depends on patient/physician preference regarding invasiveness versus repeat procedure risk.
- Coronary artery bypass grafting is a safe and effective option for selected non-diabetic patients with single vessel disease.
Abstract:
In the absence of diabetes mellitus, rates of survival and of survival free of myocardial infarction (MI) are almost identical among patients with multivessel disease assigned to percutaneous transluminal coronary angioplasty (PTCA) versus those assigned to coronary artery bypass grafting (CABG) after 6.5 to 8 year follow-up period. Additional revascularization occurs 2.5 to 4.5 times more frequently in PTCA-treated than in CABG-treated patients and prevalence of angina is no longer statistically different between the two treatment groups. The excess health care costs of bypass surgery, which are important early after revascularization, almost disappear 5 to 8 years later. In patients with single vessel disease, survival free of MI is also comparable in both treatment groups at 5 years. Additional revasculariztion occurs two to four times more often in PTCA-treated than in CABG-treated patients and prevalence of angina does not differ between the two treatment groups. Thus, in nondiabetic patients with multivessel disease, the choice of a revascularization strategy rests on the patient's and treating physician's preference between the invasive nature of bypass surgery and the risk of recurrent procedures. In patients with single vessel disease, these long-term data suggest that bypass surgery is at least as safe and effective as coronary angioplasty and therefore may be a treatment option in selected cases.
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