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(Circulation. 1997;96:2162-2170.)
© 1997 American Heart Association, Inc.
Articles |
Myocardial Infarction and Cardiac Mortality in the Bypass Angioplasty Revascularization Investigation (BARI) Randomized Trial
From Saint Louis (Mo) University School of Medicine (B.R.C., F.V.A., K.S.); University of Pittsburgh (Pa) (A.D.R., R.M.H., K.D.); Brown University (D.O.W., B.S.), Providence, RI; Montreal Heart Institute (M.G.B.); University of Michigan (B.P.), Ann Arbor; Bowman Gray School of Medicine (P.M.R.), Winston-Salem, NC; University of Alabama (W.J.R.), Birmingham; New York University (M.A.), New York; Mayo Clinic (S.S., R.F.), Rochester, Minn; Washington University (N.T.K.), St. Louis, Mo; and National Heart, Lung, and Blood Institute (G.S.), Bethesda, Md.
Correspondence to Bernard R. Chaitman, MD, FACC, Saint Louis University Health Sciences Center, Division of Cardiology (13th Floor), 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250. E-mail chaitman{at}sluvca.slu.edu
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.
Key Words: bypass • angioplasty • mortality • myocardial infarction • prognosis
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