(Circulation. 1996;93:1954-1962.)
© 1996 American Heart Association, Inc.
Articles |
Effectiveness of Revascularization in the Emory Angioplasty Versus Surgery Trial
A Randomized Comparison of Coronary Angioplasty With Bypass Surgery
From the Department of Medicine, Cardiology Division, University of Washington School of Medicine, Seattle, and Division of Interventional Cardiology, Emory University School of Medicine, Atlanta, Ga (H.X.B., A.S.K., W.S.W., S.B.K.).
Correspondence to Xue-Qiao Zhao, MD, Cardiology, Box 358771, 1914 North 34th St, Suite 105, University of Washington, Seattle, WA 98103.
Background The Emory Angioplasty Versus Surgery Trial (EAST) was designed to determine whether percutaneous transluminal coronary angioplasty (PTCA) is as effective as coronary artery bypass graft surgery (CABG) in restoring arterial perfusion capacity in eligible patients with multivessel disease.
Methods and Results Of 392 patients in EAST, 198 were
randomized to PTCA and 194 to CABG. Index lesions (2.7±1.0 per
patient) were those with 
50% stenosis judged treatable by
both angioplasty and surgery. Coronary segments jeopardized by
these index lesions were designated as index segments (4.4±1.4 per
patient). Percent stenosis was measured by quantitative
angiography at the point of greatest obstruction in the main perfusion
path of each index segment. The EAST primary arteriographic end point
was the percent of a patient's index segments with <50%
stenosis in the main perfusion pathways at 1 and 3 years. At
baseline, the percent of index segments for which
revascularization was attempted was 85% for PTCA
and 98% for CABG (P<.0001). At 1 year, PTCA patients had a
smaller percentage of successfully revascularized index segments than
CABG patients (59% versus 88%, P<.001). At 3 years, the
findings were similar but less striking (70% versus 87%,
P<.001). When only "high-priority" index segments
(2.1±1.6 per patient) were considered, baseline attempts were
comparable (96% versus 99%, P=NS); despite this, CABG
remained more successful at 1 (64% versus 93%, P<.001)
and 3 (76% versus 89%, P<.01) years. However, the mean
percent of index segments free of severe stenosis (70%) did
not differ between PTCA and CABG patients at 3 years (93% versus 95%,
P=NS). Furthermore, the frequency of patients with all index
segments free of severe stenosis did not differ between the two
groups at 1 (76% versus 83%, P=NS) or 3 (82% for both
PTCA and CABG) years.
Conclusions In patients with multivessel disease, index segment revascularization was more complete with CABG than PTCA at both 1 and 3 years. However, when the physiological priority of the target lesion and the measured severity of the residual stenosis are taken into account, the advantage of CABG becomes less significant or nonsignificant. This may, in part, explain why these two strategies did not differ in terms of the EAST primary clinical end points over 3 years.
Key Words: coronary disease • angioplasty • bypass • revascularization
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