[Comparative study of the results of coronary artery bypass grafting and angioplasty for myocardial revascularization in patients with equivalent multivessel disease].
OBJECTIVE
To investigate the relative efficacy of different therapeutic strategies in patients with symptomatic multivessel coronary artery disease with preserved ventricular function. The primary objectives were defined as a combination of death of cardiac origin, acute myocardial infarction (AMI), and refractory angina that required revascularization, and the secondary objectives were defined as anginal state and exercise-induced ischemia.


METHODS
Of the 20,769 patients assessed on cine coronary angiography at InCor, 210 were chosen for this study and were randomized either for coronary artery bypass grafting (CABG, n = 105) or transluminal coronary angioplasty (TCA, n = 105).


RESULTS
A mean of 3.2 +/- 0.8 vessels received anastomoses and 2.1 +/- 0.8 were successfully dilated in the CABG and TCA groups, respectively. In a 5-year follow-up, the rates of events in the CABG and TCA groups were, respectively: mortality, 9.52% and 12.38%; acute myocardial infarction, 2.85% and 8.57% (P = 0.0668); and additional intervention, 2.85% and 24.76% (P < 0.001). The survival rate was 88.39% for CABG and 84.93% for TCA; the respective AMI-free percentages were 84.40% and 77.40%. In the CABG and TCA groups, 62% and 60% of the patients had no angina, respectively. The exercise tests were considered nonischemic in 62.5% and 62.1% of the patients in the CABG and TCA groups, respectively.


CONCLUSIONS
In multivessel patients, compared with angioplasty, coronary artery bypass grafting was associated with a lower incidence of long-term events and a reduced need for new interventions (P = 0.001).
Silva
Paulo Roberto Dutra da
PR
Instituto do Coração, Hospital das Clínicas, FMUSP, São Paulo, SP. paulo_r_dutra@uol.com.br
Hueb
Whady Armindo
WA
César
Luiz Antônio Machado
LA
Oliveira
Sérgio Almeida de
SA
Ramires
José Antônio Franchini
JA
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome