Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease Robert.

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Presentation transcript:

Long-term survival benefits of coronary artery bypass grafting and percutaneous transluminal angioplasty in patients with coronary artery disease Robert H. Jones, MDa, Karen Kesler, MSb§, Harry R. Phillips, MDb§, Daniel B. Mark, MDb§, Peter K. Smith, MDa, Charlotte L. Nelson, MSb§, Mark F. Newman, MDc§, Joseph G. Reves, MDc§, Robert W. Anderson, MDa, Robert M. Califf, MDb§ The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 5, Pages 1013-1025 (May 1996) DOI: 10.1016/S0022-5223(96)70378-1 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Schematic diagram summarizes selection of patients for study, mode of assignment to treatment groups, and performance of subsequent procedures. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Cumulative percentage of patients undergoing a secondary procedure during the 10-year study period for patients initially treated with PTCA or CABG. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Coronary anatomy score was derived for 6034 medically treated patients undergoing coronary angiography at Duke University Medical Center between 1969 and 1984. The anatomic classification of coronary artery stenosis is related to the corresponding relative prognostic weight. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 The relative importance of seven most important baseline characteristics for predicting cardiac death for patients within the three treatment groups is summarized by the normalized χ2 values of Cox models. The Cox model χ2 is influenced both by the relative biologic importance of the variable and its prevalence in a population. The hazard ratio of each variable shows the relative increase in mortality versus the treatment group average that would be expected for an individual patient if the variable is present at the specified level. MED, Medical treatment; CHF, congestive heart failure; MI, myocardial infarction. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Adjusted Kaplan-Meier curves for the nine anatomic CAD groups show the time courses of cardiac death in the three treatment groups. The numbers of patients in each of the three treatment groups are tabulated at 2 and 4 years. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Data reflect actual treatment numbers of patients included in this study in each of nine anatomic subgroups who received CABG, PTCA, or medical treatment (MED). The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 Adjusted hazard ratios comparing CABG and medicine for the nine coronary anatomy groups. VD, Number of diseased vessels; 95%, G95% coronary artery stenosis; Prox, proximal. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 8 Adjusted hazard ratios comparing PTCA and medicine for the nine coronary anatomy groups. VD, Number of diseased vessels; 95%, G95% coronary artery stenosis; Prox, proximal. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 9 Adjusted hazard ratios comparing CABG and PTCA for the nine coronary anatomy groups. VD, Number of diseased vessels; 95%, G95% coronary artery stenosis; Prox, proximal. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 10 Absolute survival advantage of CABG and PTCA for each coronary anatomy group expressed as extra patients expected to survive for each 100 patients receiving the interventional treatment instead of medical treatment. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 11 Absolute survival advantage of CABG for each of the nine anatomic subgroups expressed as extra patients expected to survive for each 100 patients receiving CABG instead of PTCA. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 12 Mean and 95% CL hazard ratios of death at 1 year illustrate results of four randomized trials individually and combined to reflect results of 2794 randomly assigned patients. (RITA,10 EAST,11 GABI,12 and CABRI (unpublished data). All Randomized, Metaanalysis of patients in RITA, EAST, GABI, and CABRI; Duke, 3648 patients with two- and three-vessel disease reported on in this study undergoing CABG or PTCA. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 13 Cumulative percentages of patients catheterized at Duke during the time of this study with each level of CAD anatomic severity, including left main stenosis, suggests likely frequency of use of interventional treatments for CAD in catheterized patients. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Discussion Fig. 1. Relative "risk" according to severity of disease classification. 1-V, one-vessel disease; 2-V, two-vessel disease; 3-V, three-vessel disease. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Discussion Fig. 2. Hazard ratio versus relative "risk Discussion Fig. 2. Hazard ratio versus relative "risk." 1-V, one-vessel disease; 2-V, two-vessel disease; 3-V, three-vessel disease. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1013-1025DOI: (10.1016/S0022-5223(96)70378-1) Copyright © 1996 Mosby, Inc. Terms and Conditions