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Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease . The Bypass Angioplasty Revascularization Investigation ( BARI ) Investigators . BACKGROUND Coronary-artery bypass grafting ( CABG ) and percutaneous transluminal coronary angioplasty ( PTCA ) are alternative methods of revascularization in patients with coronary artery disease . We tested the hypothesis that in selected patients with multivessel disease suitable for treatment with either procedure , an initial strategy of PTCA does not result in a poorer five-year clinical outcome than CABG . METHODS Patients with multivessel disease were randomly assigned to an initial treatment strategy of CABG ( n = 914 ) or PTCA ( n = 915 ) and were followed for an average of 5.4 years . Analysis of outcome events was performed according to the intention to treat . RESULTS The respective in-hospital event rates for CABG and PTCA were 1.3 percent and 1.1 percent for mortality , 4.6 percent and 2.1 percent for Q-wave myocardial infarction ( P < 0.01 ) , and 0.8 percent and 0.2 percent for stroke . The five-year survival rate was 89.3 percent for those assigned to CABG and 86.3 percent for those assigned to PTCA ( P = 0.19 ; 95 percent confidence interval of the difference in survival , -0.2 percent to 6.0 percent ) . The respective five-year survival rates free from Q-wave myocardial infarction were 80.4 percent and 78.7 percent . By five years after study entry , 8 percent of the patients assigned to CABG had undergone additional revascularization procedures , as compared with 54 percent of those assigned to PTCA ; 69 percent of those assigned to PTCA did not subsequently undergo CABG . Among diabetic patients who were being treated with insulin or oral hypoglycemic agents at base line , a subgroup not specified by the protocol , five-year survival was 80.6 percent for the CABG group as compared with 65.5 percent for the PTCA group ( P = 0.003 ) . CONCLUSIONS As compared with CABG , an initial strategy of PTCA did not significantly compromise five-year survival in patients with multivessel disease , although subsequent revascularization was required more often with this strategy . For treated diabetics , five-year survival was significantly better after CABG than after PTCA .
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Intervention_Surgical
coronary bypass surgery
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Intervention_Surgical
angioplasty
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Intervention_Surgical
Coronary-artery bypass grafting ( CABG )
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Intervention_Surgical
percutaneous transluminal coronary angioplasty ( PTCA )
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Intervention_Surgical
CABG
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Intervention_Surgical
PTCA
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Intervention_Surgical
CABG
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Intervention_Surgical
PTCA
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Outcome_Mortality
mortality
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Outcome_Physical
Q-wave myocardial infarction
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Outcome_Physical
stroke
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Outcome_Mortality
five-year survival rate
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Outcome_Mortality
respective five-year survival rates free from Q-wave myocardial infarction
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Outcome_Other
revascularization procedures
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Outcome_Mortality
five-year survival
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Outcome_Mortality
five-year survival
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Outcome_Other
subsequent revascularization
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Outcome_Mortality
five-year survival
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Participant_Condition
patients with multivessel disease
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Participant_Condition
patients with coronary artery disease
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Participant_Condition
Among diabetic patients who were being treated with insulin or oral hypoglycemic agents at base line