CABG VS. PTCA FOR MULTIVESSEL CORONARY DISEASE: AND THE WINNER IS

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CABG VS. PTCA FOR MULTIVESSEL CORONARY DISEASE: AND THE WINNER IS.

Given a choice between percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), most patients would choose PTCA, which is less traumatic. This five-year, randomized trial compared outcomes of these strategies in 1829 patients with multivessel coronary disease and clinically severe angina or with ischemia requiring revascularization. Forty-one percent of patients had triple vessel disease, and 63 percent had unstable angina.

More of the CABG group was free of angina than the PTCA group (95 vs. 73 percent at early follow-up, and 85 vs. 79 percent at five years). Only 6 percent of the CABG patients who were asymptomatic at five years had required additional revascularization procedures, versus 52 percent of PTCA patients who were asymptomatic at five years. There were no long-term differences in exercise capacity between the two groups. Fewer CABG patients used anti-ischemic medications at five years (57 vs. 76 percent). Return-to-work rates were lower for CABG patients during the first year, but then equalized between the two groups. CABG patients reported fewer limitations in housework, sex, and interests at one year, though five-year outcome was similar in the two groups.

Comment: These data suggest that CABG offers better outcome and fewer procedures than PTCA for patients with multivessel coronary disease. Longer follow-up will be needed to fully understand outcomes. This patient population was quite symptomatic, so these trends may be less obvious in healthier patients.

— TH Lee

Published in Journal Watch General Medicine March 21, 1997

Citation(s):

The Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease: a multicenter randomized trial. JAMA 1997 Mar 5 277 715-721.