Clinical study
Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial

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Abstract

BACKGROUND

Percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) are being applied to high-risk populations, but previous randomized trials comparing revascularization methods have excluded a number of important high-risk groups.

OBJECTIVES

This five-year, multicenter, randomized clinical trial was designed to compare long-term survival among patients with medically refractory myocardial ischemia and a high risk of adverse outcomes assigned to either a CABG or a PCI strategy, which could include stents.

METHODS

Patients from 16 Veterans Affairs Medical Centers were screened to identify myocardial ischemia refractory to medical management and the presence of one or more risk factors for adverse outcome with CABG, including prior open-heart surgery, age >70 years, left ventricular ejection fraction <0.35, myocardial infarction within seven days or intraaortic balloon pump required. Clinically eligible patients (n = 2,431) underwent coronary angiography; 781 were angiographically acceptable; 454 (58% of eligible) patients consented to random assignment between CABG and PCI.

RESULTS

A total of 232 patients was randomized to CABG and 222 to PCI. The 30-day survivals for CABG and PCI were 95% and 97%, respectively. Survival rates for CABG and PCI were 90% versus 94% at six months and 79% versus 80% at 36 months (log-rank test, p = 0.46).

CONCLUSIONS

Percutaneous coronary intervention is an alternative to CABG for patients with medically refractory myocardial ischemia and a high risk of adverse outcomes with CABG.

Abbreviations

AWESOME
Angina With Extremely Serious Operative Mortality Evaluation
BARI
Bypass Angioplasty Revascularization Investigation
CAD
coronary artery disease
CABG
coronary artery bypass graft surgery
EAST
Emory Angioplasty Surgery Trial
IABP
intra-aortic balloon pump
LVEF
left ventricular ejection fraction
MI
myocardial infarction
PCI
percutaneous coronary invervention
VA
United States Department of Veterans Affairs

Cited by (0)

Supported by the Cooperative Studies Program of the United States Department of Veterans Affairs Research and Development Service. This study was presented in abstract form as a Late Breaking Trial at the Society for Cardiac Angiography and Interventions meeting, May 2001, Houston, Texas.