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Long-term survival for multivessel CAD patients similar after CABG or PTCA


Survival rates are similar in patients with multivessel coronary artery disease (CAD) 10 years after undergoing coronary artery bypass grafting (CABG) or percutaneous transluminal coronary balloon angioplasty (PTCA), study findings show.

There was a significant survival benefit for patients with type 2 diabetes who underwent CABG compared with those who received PTCA, however.

Maria Mori Brooks, of Pittsburgh University, Pennsylvania, USA, and colleagues examined the 10-year clinical outcomes of 1,829 patients with multivessel CAD enrolled in the BARI (Bypass Angioplasty Revascularization Investigation) trial. The patients were randomly assigned to undergo either PTCA or CABG.

Ten-year survival was 71% for patients who received PTCA versus 73.5% for CABG patients (p = 0.18).

Patients in the PTCA group had significantly higher revascularisation rates than those in the CABG group (76.8% vs 20.3%, p < 0.001).

Among patients with type 2 diabetes, those in the CABG group were more likely to survive than those in the PTCA group (57.8% vs 45.5%, p = 0.025).

The team says these results indicate that “CABG may have particular advantages for patients with diabetes”.

The researchers conclude in the Journal of the American College of Cardiology: “There was no significant long-term disadvantage regarding mortality or myocardial infarction associated with an initial strategy of PTCA compared with CABG”.

They add: “The steady incidence of cardiac events over the ten years of follow-up in both treatment groups emphasises that coronary revascularisation does not reverse the underlying pathophysiology of coronary disease.

“Clinical outcomes for all patients may be improved by providing long-term aggressive medical management after revascularisation.”

InCirculation 12/4/2007


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