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[Comparison between PTCA and bypass operation. Results of large randomized studies]
1Abteilung für Kardiologie, Universitätklinik-GH-Essen. tka020@sp2.power.uni-essen.de
Insights
Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) show similar outcomes for coronary artery disease patients. PTCA requires more revascularization procedures but incurs lower treatment costs.
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.
Background:
The percutaneous transluminal coronary angioplasty (PTCA) and the coronary artery bypass surgery (CABG) are established therapy modalities for the coronary artery disease. Meanwhile, first results of randomized trials comparing both therapy forms have been published.
Patients And Methods:
The results of the 6 large randomized trials (GABI, RITA CABRI, BARI, EAST, and ERACI) were compared and summarized. Inclusion criterium was coronary multivessel disease (in RITA also one-vessel-disease). Patients with left main stem stenosis, previous PTCA or CABG, severely depressed ejection fraction and total coronary occlusions were excluded in most trials. Between 127 and 1829 patients were randomized. Follow-up was 1 to 5 years.
Results:
There was no significant difference in mortality between the PTCA and the CABG-group, except in the diabetic patients of the BARI trial, who showed a significantly better survival after CABG. Mortality was 3 to 7% in most trials. The rate of myocardial infarction in the follow-up did not differ significantly. The prevalence of angina was higher in the PTCA-group in the first months after the procedure, but the difference became less marked during the follow-up. One year after the procedure, approximately 75% of the patients in the CABG-group and 70% in the PTCA-group were free from angina. The rate of additional revascularization procedures was significantly higher in the PTCA-group (32 to 54%) than in the CABG-group (3.2 to 13%). Treatment costs were significantly higher in the CABG-group.
Conclusion:
Both therapy forms were very effective concerning treatment of angina without a significant difference in mortality or frequency of myocardial infarction. The PTCA patients required more revascularization procedures, the costs for their treatment were lower than in the CABG-group. The question, whether coronary stent implantation will influence these conclusions significantly, remains open.