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Angiographic follow-up results of a randomized study on angioplasty versus bypass surgery (GABI trial). GABI Study
H J Rupprecht1, C Hamm, T Ischinger
1Medical Clinic II, University of Mainz, Germany.
Insights
Six months after treatment for multivessel disease, coronary artery bypass surgery (CABG) showed significantly more native artery occlusion than percutaneous transluminal coronary angioplasty (PTCA), despite comparable high-grade lesions in main pathways.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Multivessel coronary artery disease requires revascularization strategies.
- Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) are common treatments.
- Angiographic outcomes comparing PTCA and CABG are less understood than clinical outcomes.
Purpose of the Study:
- To compare the 6-month angiographic revascularization status after PTCA versus CABG in patients with multivessel disease.
- To assess the progression of coronary artery lesions and bypass graft patency post-intervention.
Main Methods:
- Substudy of the German Angioplasty versus Bypass Surgery Investigation (GABI Trial).
- Follow-up angiography performed 6 months after treatment in 102 CABG patients and 117 PTCA patients.
- Assessment of native artery occlusion, bypass graft occlusion, and main pathway lesion severity.
Main Results:
- Total occlusion of native arteries was significantly higher in the CABG group (36.9%) compared to the PTCA group (2.5%) at 6 months.
- Occlusion rates of bypass grafts in the CABG group were 12.2% (vein grafts 12.9%, mammary artery grafts 6.7%).
- Comparable rates of high-grade (70-100%) main pathway lesions were observed, but moderately severe (50-69%) lesions were more frequent after PTCA.
Conclusions:
- While both PTCA and CABG achieve comparable high-grade revascularization at 6 months, CABG is associated with significantly higher rates of native artery occlusion.
- Moderately severe lesions in the main pathway were more prevalent after PTCA, suggesting potential for further progression.
- These findings highlight different patterns of angiographic changes and disease progression between CABG and PTCA at 6-month follow-up.
Abstract:
Although several randomized trials have been performed to compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) in patients with multivessel disease, there is little data available on angiographic follow-up results. The present substudy of the German angioplasty versus bypass surgery investigation (GABI Trial) compares the angiographic revascularization status in these two cases 6 months after treatment. Follow-up angiograms were available in 102 CABG patients and 117 PTCA patients. Although the protocol excluded patients with total occlusion, on follow-up 6 months after treatment we found total occlusion of 94 native arteries (36.9%) in the CABG group and of six arteries (2.5%) in the PTCA group (P < 0.001). The rate of occluded native vessels did not correlate significantly with the severity of the lesion before bypass surgery. In the CABG group 31 bypass grafts (12.2%) were found to be occluded at the 6 month follow-up examination (29/225 vein grafts [12.9%]; 2/30 mammary artery grafts [6.7%]). The main pathway, defined as the nutrient vessel (native vessel or bypass graft) providing the least resistance to blood flow, was narrowed by a lesion with a diameter stenosis of 70-100% for 36 target lesions (14.1%) in the CABG group and 39 target lesions (16.2%) in the PTCA group (P, ns). However, the prevalence of moderately severe lesions with a 50-69% diameter reduction of the main pathway was significantly greater in the PTCA group (44 lesions, 18.3%) than in the CABG group (19 lesions, 7.5%, P < 0.01). Thus, 6 months after randomized allocation to PTCA or CABG, we found comparable rates of high-grade lesions in the main pathways of both treatment groups. Whereas moderately severe lesions of the main pathway were predominantly seen in the PTCA group, there was marked disease progression to total occlusion in the native circulation after bypass grafting.
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