Abstract 4681: Ten-Year Follow-up Survival of the Medicine, Angioplasty or Surgery Study (MASS-II): A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease
Background Angioplasty, coronary surgery or medical treatment have been compared in numerous studies, but long-term survival or clinical outcomes are limited, and there is no conclusive evidence that either one is superior to medical therapy (MT) alone for the treatment of multivessel CAD.
Objectives This study was designed to compare 10-year follow-up of percutaneous coronary intervention (PCI) coronary artery surgery (CABG) and continued medical treatment (MT) for patients with multivessel coronary artery disease (CAD), stable angina, and preserved ventricular function.
Methods The primary end point was defined as overall mortality, Q-wave myocardial infarction (MI), or refractory angina requiring revascularization. All data were analyzed according to the intention-to-treat-principle.
Results At a single institution a total of 611 patients were randomly assigned to either a CABG (n=203), PCI (n=205), or MT (n=203) group. The rates for 10-year survival rates were 74.9% for CABG, 75.9% for PCI, and 69% for MT (P=0.089). Regarding to combined end-points, the adjusted Cox Proportional-Hazard Ratio showed protective effect for CABG compared with MT (RR, 0.40; 95%CI 0.30 to 0.53 P<0.0001) and PCI compared with MT (RR, 0.77; 95% CI 0.60 to 0.98 P=0.037) After ten-year follow-up, 39.4 % of MT patients and 41.9% of PCI patients underwent additional interventions, compared with only 7.4% of CABG patients. (P<0.001). At ten-year follow-up,10.3% of the CABG group 13.3% of the PCI group and 20.7 % of the MT group had an uncomplicated MI (p<0.001). Furthermore, 59% of the patients in the PCI group, 64% in the CABG group, and 43 % in the MT group were free of angina (P<0.001).
Conclusions All three therapeutic regimens yielded similar and relatively low rates of overall mortality. Compared with CABG, angioplasty was associated with elevated rate of need for further revascularization. Medical therapy showed significant incidence of long-term events and high rate of additional revascularization. In addition, CABG was superior to MT for eliminating anginal symptoms.