Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease: The Bypass Angioplasty Revascularization Investigation (BARI) investigators

Robert L. Frye, Edwin L. Alderman, Katharine Andrews, James Bost, Martial Bourassa, Bernard R. Chaitman, Katherine Detre, David P. Faxon, Dean Follmann, Mark Hlatky, Robert H. Jones, Sheryl F. Kelsey, William J. Rogers, Allan D. Rosen, Hartzell V Schaff, Mary Ann Sellers, George Sopko, Kim Sutton Tyrrell, David O. Williams

Research output: Contribution to journalArticle

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Abstract

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 64 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.

Original languageEnglish (US)
Pages (from-to)217-225
Number of pages9
JournalNew England Journal of Medicine
Volume335
Issue number4
DOIs
StatePublished - Jul 25 1996

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Coronary Balloon Angioplasty
Angioplasty
Coronary Artery Bypass
Research Personnel
Survival
Survival Rate
Myocardial Infarction
Hypoglycemic Agents
Coronary Artery Disease
Stroke
Confidence Intervals
Insulin

ASJC Scopus subject areas

  • Medicine(all)

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Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease : The Bypass Angioplasty Revascularization Investigation (BARI) investigators. / Frye, Robert L.; Alderman, Edwin L.; Andrews, Katharine; Bost, James; Bourassa, Martial; Chaitman, Bernard R.; Detre, Katherine; Faxon, David P.; Follmann, Dean; Hlatky, Mark; Jones, Robert H.; Kelsey, Sheryl F.; Rogers, William J.; Rosen, Allan D.; Schaff, Hartzell V; Sellers, Mary Ann; Sopko, George; Tyrrell, Kim Sutton; Williams, David O.

In: New England Journal of Medicine, Vol. 335, No. 4, 25.07.1996, p. 217-225.

Research output: Contribution to journalArticle

Frye, RL, Alderman, EL, Andrews, K, Bost, J, Bourassa, M, Chaitman, BR, Detre, K, Faxon, DP, Follmann, D, Hlatky, M, Jones, RH, Kelsey, SF, Rogers, WJ, Rosen, AD, Schaff, HV, Sellers, MA, Sopko, G, Tyrrell, KS & Williams, DO 1996, 'Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease: The Bypass Angioplasty Revascularization Investigation (BARI) investigators', New England Journal of Medicine, vol. 335, no. 4, pp. 217-225. https://doi.org/10.1056/NEJM199607253350401
Frye, Robert L. ; Alderman, Edwin L. ; Andrews, Katharine ; Bost, James ; Bourassa, Martial ; Chaitman, Bernard R. ; Detre, Katherine ; Faxon, David P. ; Follmann, Dean ; Hlatky, Mark ; Jones, Robert H. ; Kelsey, Sheryl F. ; Rogers, William J. ; Rosen, Allan D. ; Schaff, Hartzell V ; Sellers, Mary Ann ; Sopko, George ; Tyrrell, Kim Sutton ; Williams, David O. / Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease : The Bypass Angioplasty Revascularization Investigation (BARI) investigators. In: New England Journal of Medicine. 1996 ; Vol. 335, No. 4. pp. 217-225.
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abstract = "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 64 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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T1 - Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease

T2 - The Bypass Angioplasty Revascularization Investigation (BARI) investigators

AU - Frye, Robert L.

AU - Alderman, Edwin L.

AU - Andrews, Katharine

AU - Bost, James

AU - Bourassa, Martial

AU - Chaitman, Bernard R.

AU - Detre, Katherine

AU - Faxon, David P.

AU - Follmann, Dean

AU - Hlatky, Mark

AU - Jones, Robert H.

AU - Kelsey, Sheryl F.

AU - Rogers, William J.

AU - Rosen, Allan D.

AU - Schaff, Hartzell V

AU - Sellers, Mary Ann

AU - Sopko, George

AU - Tyrrell, Kim Sutton

AU - Williams, David O.

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N2 - 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 64 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.

AB - 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 64 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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