Related Experiment Video
Updated: Aug 25, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
A randomized trial comparing coronary angioplasty with coronary bypass surgery. Emory Angioplasty versus Surgery
S B King1, N J Lembo, W S Weintraub
1Division of Cardiology, Emory University School of Medicine, Atlanta, GA.
Insights
Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) showed similar outcomes for multivessel coronary artery disease. Patient preference and need for future procedures should guide treatment selection.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- The comparative clinical effectiveness of coronary artery bypass grafting (CABG) versus percutaneous transluminal coronary angioplasty (PTCA) for multivessel coronary artery disease remains unclear.
- A prospective, randomized trial was designed to compare outcomes between CABG and PTCA in patients undergoing their first coronary revascularization procedure.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of CABG compared to PTCA in patients with multivessel coronary artery disease.
- To assess differences in mortality, myocardial infarction, ischemia, and need for repeat revascularization between the two treatment groups.
Main Methods:
- A randomized trial involving 392 patients with multivessel coronary artery disease.
- Patients were assigned to either CABG or PTCA.
- Follow-up included clinical assessments, coronary arteriography, and thallium stress scanning at one and three years. The primary endpoint was a composite of death, Q-wave myocardial infarction, and significant ischemia at three years.
Main Results:
- No significant difference was observed in the primary endpoint between CABG and PTCA groups (27.3% vs. 28.8%, P=0.81).
- Mortality rates were similar (6.2% for CABG vs. 7.1% for PTCA).
- CABG patients required significantly fewer repeat revascularization procedures (1% vs. 22% for surgery, 13% vs. 41% for angioplasty; P < 0.001) and showed better angiographic revascularization at three years. Angina was more frequent in the PTCA group.
Conclusions:
- CABG and PTCA offer comparable efficacy regarding the composite primary endpoint in patients with multivessel coronary artery disease.
- Treatment decisions should consider patient preferences, quality of life, and the likelihood of requiring subsequent revascularization procedures.
Background:
The clinical benefit of percutaneous transluminal coronary angioplasty (PTCA) as compared with coronary-artery bypass grafting (CABG) for patients with multivessel coronary artery disease has not been established. To determine the outcomes of these treatments in patients referred for the first time for coronary revascularization, we conducted a three-year prospective, randomized trial comparing the two procedures.
Methods:
Revascularization was performed by accepted methods. Follow-up clinical information was collected every six months, and coronary arteriography and thallium stress scanning were performed at one and three years. The primary end point was a composite of death, Q-wave myocardial infarction, and a large ischemic defect identified on thallium scanning at three years. Secondary end points included clinical and angiographic status and the need for additional revascularization procedures. Data were analyzed according to the intention-to-treat principle.
Results:
Of the 5118 patients screened for the trial, 842 (16.5 percent) were eligible for enrollment, and 392 (7.7 percent) agreed to participate. A total of 194 patients were randomly assigned to the CABG group, and 198 to the PTCA group. The primary end point occurred in 27.3 percent of the CABG group and 28.8 percent of the PTCA group (P = 0.81). Death occurred in 6.2 percent of the CABG group and 7.1 percent of the PTCA group (P = 0.73 by log-rank test). At three years, the proportions of patients in the CABG group who required repeated bypass surgery (1 percent) or angioplasty (13 percent) were significantly lower than the proportions in the PTCA group (22 and 41 percent, respectively; P < 0.001). Angiographic studies at three years showed a greater degree of revascularization in the CABG group. Angina was more frequent in the PTCA group (20 percent) than in the CABG group (12 percent).
Conclusions:
We found that CABG and PTCA did not differ significantly with respect to the occurrence of the composite primary end point. Consequently, the selection of one procedure over the other should be guided by patients' preferences regarding the quality of life and the possible need for subsequent procedures.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Peripheral Artery Disease III: Interprofessional Care