[Comparison between PTCA and bypass operation. Results of large randomized studies]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) are established treatments for coronary artery disease (CAD).
• Recent randomized trials have begun comparing the efficacy and outcomes of PTCA versus CABG.

Purpose of the Study:

• To compare the long-term outcomes of PTCA and CABG in patients with coronary multivessel disease.
• To evaluate differences in mortality, myocardial infarction, angina prevalence, revascularization rates, and treatment costs.

Main Methods:

• A meta-analysis of 6 large randomized trials (GABI, RITA, CABRI, BARI, EAST, ERACI) involving patients with coronary multivessel disease.
• Exclusion criteria included left main stem stenosis, prior PTCA/CABG, severely depressed ejection fraction, and total occlusions.
• Patient numbers ranged from 127 to 1829, with follow-up periods of 1 to 5 years.

Main Results:

• No significant difference in overall mortality or myocardial infarction rates between PTCA and CABG.
• Diabetic patients in the BARI trial showed significantly better survival with CABG.
• Angina prevalence was initially higher with PTCA but diminished over time; PTCA patients required significantly more revascularization procedures.
• Treatment costs were significantly higher for CABG.

Conclusions:

• Both PTCA and CABG are effective for angina treatment with comparable mortality and myocardial infarction rates.
• PTCA is associated with higher revascularization rates and lower treatment costs compared to CABG.
• The impact of coronary stent implantation on these comparisons remains an open question.