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(Circulation. 2001;103:1076.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Similarity of Ventricular Function in Patients Alive 5 Years After Randomization to Surgery or Angioplasty in the BARI Trial

Raymond J. Gibbons, MD; D. Douglas Miller, MD; Peter Liu, MD; Ping Guo, MSc; Maria Mori Brooks, PhD; Markus Schwaiger, MD

From Mayo Clinic, Rochester, Minn (R.J.G.); Saint Louis University School of Medicine, St Louis, Mo (D.D.M.); Toronto General Hospital, Toronto, Ontario, Canada (P.L.); University of Pittsburgh, Pittsburgh, Pa (P.G., M.M.B.); and Klinikum rechts der Isar der Technischen Universität Muenchen, Munich, Germany (M.S.).

Correspondence to Raymond J. Gibbons, MD, Mayo Clinic, East 16 A, 200 First St SW, Rochester, MN 55905. E-mail gibbons.raymond{at}mayo.edu

Background—Left ventricular ejection fraction (LVEF) is a recognized determinant of survival in patients with coronary artery disease. In major trials comparing surgical and percutaneous revascularization approaches, the long-term effect of the coronary revascularization strategy on LVEF has not been reported.

Methods and Results—In the NHLBI-sponsored Bypass and Angioplasty Revascularization Investigation (BARI) randomized trial comparing angioplasty and bypass surgery as initial treatment strategies, 1220 (75%) of the 1617 surviving randomized patients had their EF measured by radionuclide ventriculography 5 years after study entry. For the total study group, the 5-year EF in the CABG group (n=623) was 55.8±12.3, compared with 55.7±12.7 in PTCA group (n=597, P=0.82). There was no significant difference in measured EF between the CABG group and the PTCA group within multiple subgroups determined by the presence or absence of diabetes, 3-vessel disease, complete revascularization, or prior myocardial infarction. In a multiple linear regression model developed to predict 5-year EF, treatment assignment to PTCA or CABG was not significant (P=0.95). If an EF of 0 was imputed for patients who were dead and missing EF data, however, there was a higher EF in the CABG group (P=0.0018) among diabetic patients only.

Conclusions—In the BARI randomized trial, initial treatment assignment to angioplasty was not associated with any difference in long-term ventricular function compared with initial treatment assignment to surgery. These results apply, however, only to patients who were alive at 5 years.

Key Words: ventricles • bypass • angioplasty • coronary disease

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