Author(s): BARI Investigators
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Abstract OBJECTIVES: We sought to compare 10-year clinical outcomes in the BARI (Bypass Angioplasty Revascularization Investigation) trial patients who were randomly assigned to percutaneous transluminal coronary balloon angioplasty (PTCA) versus coronary artery bypass grafting (CABG). BACKGROUND: Angioplasty and bypass surgery have been compared in numerous studies, but long-term clinical outcomes are limited. METHODS: Symptomatic patients with multivessel coronary artery disease (n = 1,829) were randomly assigned to initial treatment with PTCA or CABG and followed up for an average of 10.4 years. Analyses were conducted on an intention-to-treat basis. RESULTS: The 10-year survival was 71.0\% for PTCA and 73.5\% for CABG (p = 0.18). At 10 years, the PTCA group had substantially higher subsequent revascularization rates than the CABG group (76.8\% vs. 20.3\%, p < 0.001), but angina rates for the 2 groups were similar. In the subgroup of patients with no treated diabetes, survival rates were nearly identical by randomization (PTCA 77.0\% vs. CABG 77.3\%, p = 0.59). In the subgroup with treated diabetes, the CABG assigned group had higher survival than the PTCA assigned group (PTCA 45.5\% vs. CABG 57.8\%, p = 0.025). CONCLUSIONS: There was no significant long-term disadvantage regarding mortality or myocardial infarction associated with an initial strategy of PTCA compared with CABG. Among patients with treated diabetes, CABG conferred long-term survival benefit, whereas the 2 initial strategies were equivalent regarding survival for patients without diabetes.
This article was published in J Am Coll Cardiol
and referenced in Translational Medicine