Ten-year results of the randomized control trials of coronary artery bypass graft surgery: tabular data compiled by the collaborative effort of the original trial investigators. Part 1 of 2.
OBJECTIVE
To make available 10-year mortality data compiled and analyzed on patients with stable coronary heart disease (angina not severe enough to necessitate surgery) from all studies in which patients were randomized to initial coronary artery bypass graft (CABG) surgery or initial medical treatment and to determine whether the effects are influenced by the extent of coronary artery disease and degree of left-ventricular function. Data and analyses are presented in tabular form; text is published simultaneously in Lancet.


METHODS
We collected individual patient data using standardized forms and, whenever possible, uniform definitions. We used Mantel-Haentel methods to combine data. Restricted means analyses were applied to quantify the extension in survival, and logistic regression analyses were applied to assess whether any baseline covariate affected the treatment differences.


RESULTS
Of 2,649 patients, 1,324 were assigned to receive CABG surgery and 1,325 to the medical group. Mean age was 50.8 years; 98.8% were men. 93.7% of the CABG group underwent surgery. 25% of the medical group had undergone surgery at 5 years, 33% at 7 years, and 41% at 10 years. Initial CABG surgery reduced mortality significantly at 5 years (10.2% vs 15.8%; OR = 0.61; P < 0.001), 7 years (15.8% vs 21.7%; OR = 0.68; P < 0.001), and 10 years (26.4% vs 30.5%; OR = 0.83; P < 0.03). Risk reductions were most pronounced in patients with left-main disease compared to those with 3- or 1-2-vessel disease (at 5 years OR = 0.32, 0.58, and 0.77, respectively).


CONCLUSIONS
Initial CABG surgery compared to initial medical management reduces mortality, especially in high- and medium-risk patients.
Yusuf
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National Heart, Lung, and Blood Institute, Bethesda, MD.
Zucker
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Chalmers
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TC
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis