title: 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. Investigators of the Department of Veterans Affairs Cooperative Study #385, the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME).
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Tucson VA Medical Center, University of Arizona SAVAHCS, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Morrison
authors.forename: G
authors.initials: G
authors.lastname: Sethi
authors.forename: J
authors.initials: J
authors.lastname: Sacks
authors.forename: W
authors.initials: W
authors.lastname: Henderson
authors.forename: F
authors.initials: F
authors.lastname: Grover
authors.forename: S
authors.initials: S
authors.lastname: Sedlis
authors.forename: R
authors.initials: R
authors.lastname: Esposito
authors.forename: K
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authors.lastname: Ramanathan
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authors.initials: D
authors.lastname: Weiman
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authors.lastname: Saucedo
authors.forename: T
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authors.lastname: Antakli
authors.forename: V
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authors.lastname: Paramesh
authors.forename: S
authors.initials: S
authors.lastname: Pett
authors.forename: S
authors.initials: S
authors.lastname: Vernon
authors.forename: V
authors.initials: V
authors.lastname: Birjiniuk
authors.forename: F
authors.initials: F
authors.lastname: Welt
authors.forename: M
authors.initials: M
authors.lastname: Krucoff
authors.forename: W
authors.initials: W
authors.lastname: Wolfe
authors.forename: J C
authors.initials: JC
authors.lastname: Lucke
authors.forename: S
authors.initials: S
authors.lastname: Mediratta
authors.forename: D
authors.initials: D
authors.lastname: Booth
authors.forename: C
authors.initials: C
authors.lastname: Barbiere
authors.forename: D
authors.initials: D
authors.lastname: Lewis
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000401:mortality / Q000601:surgery / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D006801:Humans; D017202:Myocardial Ischemia / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D015607:Stents