Five-year mortality for stable angina in a medical practice study and a randomized trial.
OBJECTIVE
Evolution of revascularization and medical therapy has increased the probability of improved survival in patients with stable angina. The present investigation tests the hypothesis that medical practice will generate lower mortality than randomly assigned bypass surgery in the European Coronary Surgery Study (ECSS) two decades earlier.


METHODS
Using eligibility criteria of ECSS, a clinical decision strategy (CDS) cohort of 362 patients was selected from a nationwide study of medical practice in Sweden. Access to the individual data allowed common protocol design to compare 5-year mortality between CDS and surgical strategy of ECSS.


CONCLUSIONS
CDS advised bypass surgery (BS) or percutaneous transluminal coronary angioplasty (PTCA) in 93% and medical treatment alone in 7%, while 94% of 394 patients randomized to surgery (Euro-S) in ECSS obtained BS. Operative mortality was 3.2% for Euro-S while no operative deaths occurred in CDS reflecting medical progress during two decades. However, the 5-year mortality for CDS decreased first when the risk ratio was adjusted for age, diabetes mellitus and hypertension (RR = 0.49 with 95% CI 0.26-0.93) p = 0.03 suggesting a need for improved comprehensive medical care.
Varnauskas
Edvardas
E
The European Coronary Surgery Study, Göteborg University, Göteborg, Sweden. ed.varna@telia.com
Aberg
Torkel
T
Brorsson
Bengt
B
Karlsson
Thomas
T
Olsson
Bertil
B
Werkö
Lars
L
D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D004358:Drug Therapy / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012306:Risk; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome