Contemporary percutaneous coronary intervention versus balloon angioplasty for multivessel coronary artery disease: a comparison of the National Heart, Lung and Blood Institute Dynamic Registry and the Bypass Angioplasty Revascularization Investigation (BARI) study.
BACKGROUND
This investigation compares the results of contemporary percutaneous coronary intervention (PCI) with standard balloon angioplasty among patients with multivessel coronary disease. Patients having balloon angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI) and those within the Dynamic Registry meeting BARI eligibility criteria were studied.


RESULTS
Clinical features and in-hospital and 1-year outcomes of 857 BARI-eligible patients in the Dynamic Registry (contemporary PCI) were compared with the 904 randomized patients who underwent percutaneous transluminal coronary angioplasty in BARI. Compared with BARI patients, Registry patients had fewer lesions attempted (1.53 versus 2.56, P=0.001), more frequent single-vessel PCI (76% versus 33%, P<0.001), greater use of intracoronary stents (76% versus 1%, P<0.001), and GP IIb/IIIa receptor antagonist (24% versus 0%, P<0.001). Angiographic success was achieved more often among Registry patients (91% versus 72%, P<0.001), whereas abrupt closure (1.5% versus 9.5%, P<0.001) and in-hospital coronary artery bypass graft (CABG) (1.9% versus 10.2%, P<0.001) and myocardial infarction (0.8% versus 2.1%, P=0.025) were less common. No differences were observed in either in-hospital or 1-year death, but 1-year death/myocardial infarction was lower in the Registry. Registry patients had lower 1-year rates of subsequent CABG (8.6% versus 22.7%, P<0.001) and PCI (12.4% versus 22.5%, P<0.001). By multivariate analysis, contemporary PCI was independently associated with reduced risk for in-hospital CABG, 1-year CABG, and 1-year PCI.


CONCLUSIONS
Among patients with multivessel disease, contemporary PCI resulted in safer and more durable revascularization. These results support the role of PCI for selected patients with multivessel coronary artery disease.
Srinivas
V S
VS
Department of Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
Brooks
Maria Mori
MM
Detre
Katherine M
KM
King
Spencer B
SB
Jacobs
Alice K
AK
Johnston
Janet
J
Williams
David O
DO
D000800:Angioplasty, Balloon / Q000009:adverse effects; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000009:adverse effects; D009316:National Institutes of Health (U.S.); D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology