Presentation on theme: "Ten-Year Follow-up Survival of the Medicine, Angioplasty, or Surgery Study (MASS-II): a Randomized Controlled Clinical Trial of Therapeutic Strategies."— Presentation transcript:
Ten-Year Follow-up Survival of the Medicine, Angioplasty, or Surgery Study (MASS-II): a Randomized Controlled Clinical Trial of Therapeutic Strategies for Multivessel Coronary Artery Disease Whady Hueb, Neuza Lopes, Bernard J. Gersh, Paulo R. Soares, Expedito E. Ribeiro, Alexandre C. Pereira, Desiderio Favarato, Antonio Sérgio C. Rocha, Alexandre C. Hueb and Jose A.F. Ramires Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
Competing Interests The authors declare no potential competing interest.
Compared to CABG treatment, PCI or MT is associated with higher rates of angina and subsequent revascularization, but no significant differences in mortality or rates of MI have been found. Revascularization therapy in stable multivessel coronary artery disease (CAD) and preserved ventricular function remains controversial. BACKGROUND
To our Knowledge, there is no study that has ever compared end points among these 3 therapeutic strategies for more than a 5-year follow-up period. BACKGROUND
To compare 10-year follow-up survival of the medical treatment, angioplasty, or surgical strategies among patients with stable multivessel CAD and preserved ventricular function. OBJECTIVE
METHODSRANDOMIZATION ANGIOPLASTY(BMS) MEDICAL TREATMENT (alone) SURGERY (on-pump CABG) Stable Angina Multivessel Coronary Artery Disease Preserved Left Ventricular Function Surgeon / Interv. Cardiologist / Clinical Cardiologist Team approval Recruitment: May 1995 - May 2000 (Heart Institute - InCor) Hueb W., et al. Circulation 2007;115:1082-1089
All analysis were done according to intention to treat principle. Sample size: power 80% and a two-side level of significance of 0.05% - 191 patients in each group. Statistical test: Chi-Square, log-rank test, ANOVA, Tukey multiple-comparisons test, Cox’s regression and McNemar test. Statistical Analysis
RESULTS Hueb W, et al. J Am Coll CardioI 2004; 43:1743-51 1465 patients non-randomized: Surgery(n=203) Medical Treatment (n=203) Angioplasty (n=205) excluded 18.692 patients: coronary <30% lesion - 5192 single coronary disease - 3531 previous CABG/PCI - 2908 valvar disease 2701 other - 4361 refused to participate in this trial or refused the surgical procedure Database: 20.769 coronary angiographies Elegible: 2.076 patients (suitable to PCI-CABG) MASS II Randomized: 611 patients
Demographic Profile Male, (%) Age (years) mean±SD Medical History Previous MI, (%) Smoker, (%) Hypertension, (%) Diabetes mellitus, (%) CCS class 2 or 3, (%) 6960±93933553678 MT (n = 203) MT (n = 203) 72 61±8 4132632985 CABG (n = 203) CABG (n = 203) 6760±45227602676 PCI (n=205) PCI (n=205) Characteristic 0.4120.9590.0240.0130.2150.0620.006 P P Baseline Characteristics of MASS II
CONCLUSION All three therapeutic regimens yielded similar and relatively low rates of overall mortality. Compared with CABG, angioplasty was associated with elevated rate of myocardial infarction and need for revascularization. Medical therapy showed significant incidence of myocardial infarction and high rate of additional revascularization.