Percutaneous coronary intervention versus repeat bypass surgery for patients with medically refractory myocardial ischemia: AWESOME randomized trial and registry experience with post-CABG patients.
OBJECTIVE
This report compares long-term percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) survival among post-CABG patients included in the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) randomized trial and prospective registry.


BACKGROUND
Repeat CABG surgery is associated with a higher risk of mortality than first-time CABG. The AWESOME is the first randomized trial comparing CABG with PCI to include post-CABG patients.


METHODS
Over a five-year period (1995 to 2000), patients at 16 hospitals were screened to identify a cohort of 2,431 individuals who had medically refractory myocardial ischemia and at least one of five high-risk factors. There were 454 patients in the randomized trial, of whom 142 had prior CABG. In the physician-directed registry of 1,650 patients, 719 had prior CABG. Of the 327 patient-choice registry patients, 119 had at least one prior CABG. The CABG and PCI survivals for the three groups were compared using Kaplan-Meier curves and log-rank tests.


RESULTS
The CABG and PCI three-year survival rates were 73% and 76% respectively for the 142 randomized patients (75 and 67 patients) (log-rank = NS). In the physician-directed registry, 155 patients were assigned to reoperation and 357 to PCI (207 received medical therapy); 36-month survivals were 71% and 77% respectively (log-rank = NS). In the patient-choice registry, 32 patients chose reoperation and 74 chose PCI (13 received medical therapy); 36-month survivals were 65% and 86% respectively (log-rank test p = 0.01).


CONCLUSIONS
Percutaneous coronary intervention is preferable to CABG for many post-CABG patients.
Morrison
Douglass A
DA
Tucson VA Medical Center and the University of Arizona, Tucson, Arizona 85723, USA. douglass.morrisson@med.va.gov
Sethi
Gulshan
G
Sacks
Jerome
J
Henderson
William G
WG
Grover
Frederick
F
Sedlis
Steven
S
Esposito
Rick
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003657:Decision Making; D018572:Disease-Free Survival; D006801:Humans; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013995:Time; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology