3 CABG VS MULTIVESSEL PCI Bypass Angioplasty Revascularization Investigation TrialMulticenter randomized trial comparing CABG & PTCAEligible pts had symptomatic CAD or severe Ischemia on exercise testing, and angio proven stenosis >50% in > 1 myocardial territoryN IN 18 centres betw. AUG1988 – Aug1991Primary outcomes -- cumulative rates of survival, Q-wave M .I, and survival free of Q-wave M.Iin-hospital complications, crossovers & TVRBetween August 1988 and August 1991, 1829patients at 18 clinical centers were randomizedto undergo either CABG or PTCA.1 Themean age was 61 years, and one fourth of thecohort were women. More than half of thepatients had a history of myocardial infarction,and 9% had a history of treated congestiveheart failure. Approximately 20% had diabetestreated with oral agents or insulin; another 5%had untreated diabetes. Two thirds of thepatients had unstable angina.Forty-one percent of patients had triplevesseldisease; more than one third had at leastone totally occluded coronary artery. Overall,the mean percentage of myocardium jeopardizedby a lesion of at least 50% was 61%.Twenty-two percent of the patients had anejection fraction less than 50%. None of thesebaseline characteristics were significantly differentbetween the treatment groups.
4 RESULTSThe rates of in-hospital mortality were similar 1.3% with CABG VS 1.1% with PTCAMore patients assigned to CABG had Q-wave myocardial infarctions in the hospitalthan did patients assigned to PTCA, 4-5% vs 2.1% (P < .01)TVR more in PTCA (6.3% IN PTCA VS 0.1% in CABG group P < .001)
6 CABRI TRIAL Objective: RCT CABG VS PCI N- 1054 Conclusion: In patients with multivessel coronary disease and chronicocclusion of a major epicardial vessel, achieving of a complete revascularization by reopening or bypassing the occluded vessel is associated witha significantly better long-term prognosis.
8 ARTSOBJECTIVES The long-term (five-year) comparative results of treatment of multivessel coronary arterydisease with stenting or coronary artery bypass grafting (CABG) is at present unknown.BACKGROUND The Arterial Revascularization Therapies Study (ARTS) was designed to compare CABGand stenting in patients with multivessel disease.METHODS A total of 1,205 patients with the potential for equivalent revascularization were randomlyassigned to CABG (n 605) or stent implantation (n 600). The primary clinical end pointwas freedom from major adverse cardiac and cerebrovascular events (MACCE) at one year;MACCE at five-year follow-up constituted the final secondary end point.RESULTS At five years, there were 48 and 46 deaths in the stent and CABG groups, respectively (8.0%vs. 7.6%; p 0.83; relative risk [RR], 1.05; 95% confidence interval [CI], 0.71 to 1.55).Among 208 diabetic patients, mortality was 13.4% in the stent group and 8.3% in the CABGgroup (p 0.27; RR, 1.61; 95% CI, 0.71 to 3.63). Overall freedom from death, stroke, ormyocardial infarction was not significantly different between groups (18.2% in the stent groupvs. 14.9% in the surgical group; p 0.14; RR, 1.22; 95% CI, 0.95 to 1.58). The incidenceof repeat revascularization was significantly higher in the stent group (30.3%) than in theCABG group (8.8%; p ; RR, 3.46;95% CI, 2.61 to 4.60). The composite event-freesurvival rate was 58.3% in the stent group and 78.2% in the CABG group (p ; RR,1.91;95% CI, 1.60 to 2.28).CONCLUSIONS At five years there was no difference in mortality between stenting and surgery for multivesseldisease. Furthermore, the incidence of stroke or myocardial infarction was not significantlydifferent between the two groups. However, overall MACCE was higher in the stent group,driven by the increased need for repeat revascularization.