Similarity of ventricular function in patients alive 5 years after randomization to surgery or angioplasty in the BARI trial.
BACKGROUND
Left ventricular ejection fraction (LVEF) is a recognized determinant of survival in patients with coronary artery disease. In major trials comparing surgical and percutaneous revascularization approaches, the long-term effect of the coronary revascularization strategy on LVEF has not been reported.


RESULTS
In the NHLBI-sponsored Bypass and Angioplasty Revascularization Investigation (BARI) randomized trial comparing angioplasty and bypass surgery as initial treatment strategies, 1220 (75%) of the 1617 surviving randomized patients had their EF measured by radionuclide ventriculography 5 years after study entry. For the total study group, the 5-year EF in the CABG group (n=623) was 55.8+/-12.3, compared with 55.7+/-12.7 in PTCA group (n=597, P:=0.82). There was no significant difference in measured EF between the CABG group and the PTCA group within multiple subgroups determined by the presence or absence of diabetes, 3-vessel disease, complete revascularization, or prior myocardial infarction. In a multiple linear regression model developed to predict 5-year EF, treatment assignment to PTCA or CABG was not significant (P:=0.95). If an EF of 0 was imputed for patients who were dead and missing EF data, however, there was a higher EF in the CABG group (P:=0.0018) among diabetic patients only.


CONCLUSIONS
In the BARI randomized trial, initial treatment assignment to angioplasty was not associated with any difference in long-term ventricular function compared with initial treatment assignment to surgery. These results apply, however, only to patients who were alive at 5 years.
Mayo Clinic, Rochester, MN 55905, USA. gibbons.raymond@mayo.edu
R J
RJ
Gibbons
D D
DD
Miller
P
P
Liu
P
P
Guo
M M
MM
Brooks
M
M
Schwaiger
D017130:Angioplasty; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010043:Outcome and Process Assessment, Health Care; D013318:Stroke Volume; D016277:Ventricular Function, Left