Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: A multicenter, randomized trial

Douglass A. Morrison, Gulshan Sethi, Jerome Sacks, William Henderson, Frederick Grover, Steven Sedlis, Rick Esposito, Kodangudi Ramanathan, Darryl Weiman, Jorge Saucedo, Tamim Antakli, Venki Paramesh, Stuart Pert, Sarah Vernon, Vladimir Birjiniuk, Frederick Welt, Mitchell Krucoff, Walter Wolfe, John C. Lucke, Sundeep MedirattaDavid Booth, Charles Barbiere, Daniel Lewis

Research output: Contribution to journalArticlepeer-review

249 Citations (SciVal)

Abstract

BACKGROUND: Percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) are being applied to high-risk populations, but previous randomized trials comparing revascularization methods have excluded a number of important high-risk groups. OBJECTIVES: This five-year, multicenter, randomized clinical trial was designed to compare long-term survival among patients with medically refractory myocardial ischemia and a high risk of adverse outcomes assigned to either a CABG or a PCI strategy, which could include stents. METHODS: Patients from 16 Veterans Affairs Medical Centers were screened to identify myocardial ischemia refractory to medical management and the presence of one or more risk factors for adverse outcome with CABG, including prior open-heart surgery, age >70 years, left ventricular ejection fraction <0.35, myocardial infarction within seven days or intraaortic balloon pump required. Clinically eligible patients (n = 2,431) underwent coronary angiography; 781 were angiographically acceptable; 454 (58% of eligible) patients consented to random assignment between CABG and PCI. RESULTS: A total of 232 patients was randomized to CABG and 222 to PCI. The 30-day survivals for CABG and PCI were 95% and 97%, respectively. Survival rates for CABG and PCI were 90% versus 94% at six months and 79% versus 80% at 36 months (log-rank test, p = 0.46). CONCLUSIONS: Percutaneous coronary intervention is an alternative to CABG for patients with medically refractory myocardial ischemia and a high risk of adverse outcomes with CABG.

Original languageEnglish
Pages (from-to)143-149
Number of pages7
JournalJournal of the American College of Cardiology
Volume38
Issue number1
DOIs
StatePublished - 2001

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: A multicenter, randomized trial'. Together they form a unique fingerprint.

Cite this