(Circulation. 2000;101:2795.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Long-Term Clinical Outcome in the Bypass Angioplasty Revascularization Investigation Registry
Comparison With the Randomized Trial
From the Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (A.R., M.M.B., K.M.D.); New York University Medical Center, New York, NY (F.F., N.M.K., M.J.A.); NHLBI, Bethesda, Md (G.S.); Jewish Hospital, St Louis, Mo (R.K.); Mayo Clinic, Rochester, Minn (P.B.B., R.F.); Boston University, Boston, Mass (R.S.); Rhode Island Hospital, Providence (D.O.W.); for the BARI Investigators. A complete listing of the BARI investigators has been published: Circulation. 1991;84(suppl V):V-23–V-27.
Correspondence to Frederick Feit, MD, NYU Medical Center, 560 First Ave, Room H576, New York, NY 10016. E-mail frederick.feit{at}nyu.med.edu
Background—The Bypass Angioplasty Revascularization Investigation (BARI) included 4039 patients with multivessel coronary artery disease; 1829 consented to randomization, and 2010 did not but were followed up in a registry. Thus, we can evaluate the outcome of physician-guided versus random assignment of percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass graft surgery (CABG).
Methods and Results—We compared the baseline features and outcomes for PTCA and CABG in the overall registry and its predesignated subgroups. We assessed the impact of treatment by choice versus random assignment by comparing the results in the registry with those of the randomized trial. Statistical adjustments for differences in baseline characteristics were made. Within the registry, nearly twice as many patients were selected for PTCA (1189) as CABG (625); mortality at 7 years was similar for PTCA (13.9%) and CABG (14.2%) (P=0.66) before and after adjustment for baseline differences between patients selected for PTCA versus CABG (adjusted RR, 1.02; P=0.86). In contrast to the randomized trial, the 7-year mortality rate of treated diabetics in the registry was equally high (26%) with PTCA or CABG. Seven-year mortality was higher for patients undergoing PTCA in the randomized trial than in the registry (19.1% versus 13.9%, P<0.01) but not for those undergoing CABG (15.6% versus 14.2%, P=0.57). The adjusted relative mortality risk for PTCA in the randomized versus registry population was 1.17 (P=0.16).
Conclusions—BARI physicians were able to select PTCA rather than CABG for 65% of registry patients who underwent revascularization without compromising long-term survival either in the overall population or in treated diabetics.
Key Words: atherosclerosis • coronary disease • angioplasty • bypass • revascularization
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