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Myocardial infarction and cardiac mortality in the Bypass Angioplasty Revascularization Investigation (BARI)
B R Chaitman1, A D Rosen, D O Williams
1Saint Louis University School of Medicine, Mo 63110-0250, USA. chaitman@sluvca.slu.edu
Insights
Coronary artery bypass grafting (CABG) showed lower 5-year cardiac mortality than percutaneous transluminal coronary angioplasty (PTCA) in multivessel disease patients. This difference was significant for diabetic patients but not for nondiabetic patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are primary revascularization strategies.
- Evaluating long-term outcomes, including cardiac mortality and myocardial infarction (MI), is crucial for treatment selection in multivessel disease.
Purpose of the Study:
- To compare 5-year rates of cardiac mortality and MI between CABG and PTCA in patients with multivessel coronary artery disease.
Main Methods:
- The Bypass Angioplasty Revascularization Investigation (BARI) trial randomized 1829 patients with multivessel disease to either CABG or PTCA.
- Outcomes including cardiac death and MI were assessed over a 5-year follow-up period.
Main Results:
- Five-year cardiac mortality was significantly higher with PTCA (8.0%) compared to CABG (4.9%) (RR 1.55, P=.022).
- In diabetic patients, cardiac mortality was significantly greater after PTCA than CABG.
- No significant differences in cardiac mortality or the composite endpoint of death/MI were observed in nondiabetic patients.
Conclusions:
- Initial treatment with CABG resulted in significantly lower 5-year cardiac mortality than PTCA in patients with multivessel disease, particularly evident in diabetic individuals.
- For nondiabetic patients, neither CABG nor PTCA showed a significant difference in cardiac mortality or the composite endpoint of death/MI.
Background:
Cardiac mortality and myocardial infarction (MI) rates are used to evaluate the efficacy of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). We compared 5-year cardiac mortality and MI rates in 1829 patients with multivessel disease randomized to CABG or PTCA.
Methods And Results:
The 5-year cardiac mortality rate was 8.0% in patients assigned to PTCA compared with 4.9% in those assigned to CABG (relative risk [RR] of 1.55 with a 95% confidence interval [CI] of 1.07 to 2.23; P=.022). In a subgroup of 1476 nondiabetic patients, there were no significant differences between treatment groups in cardiac mortality either overall (4.6% versus 4.2%; RR= 1.04, 95% CI, 0.65 to 1.66; P=.908) or in subgroups based on symptoms, left ventricular function, number of diseased vessels, or stenotic proximal left anterior descending artery. The two treatment groups had similar event rates for the combined end point of cardiac death or MI. The RR for cardiac mortality in 264 patients who sustained an MI compared with those who did not was 5.9 (P<.001). MIs were more common after CABG during index hospitalization (P=.004), but in the PTCA group, they were more common after discharge (P<.001).
Conclusions:
The Bypass Angioplasty Revascularization Investigation (BARI) trial indicates 5-year cardiac mortality in patients with multivessel disease was significantly greater after initial treatment with PTCA than with CABG. The difference was manifest in diabetic patients on drug therapy. There were no significant differences overall for the composite end point of cardiac mortality or MI between treatment groups or for cardiac mortality in nondiabetic patients regardless of symptoms, left ventricular function, number of diseased vessels, or stenotic proximal left anterior descending artery.