The final 10-year follow-up results from the BARI randomized trial.
OBJECTIVE
We sought to compare 10-year clinical outcomes in the BARI (Bypass Angioplasty Revascularization Investigation) trial patients who were randomly assigned to percutaneous transluminal coronary balloon angioplasty (PTCA) versus coronary artery bypass grafting (CABG).


BACKGROUND
Angioplasty and bypass surgery have been compared in numerous studies, but long-term clinical outcomes are limited.


METHODS
Symptomatic patients with multivessel coronary artery disease (n = 1,829) were randomly assigned to initial treatment with PTCA or CABG and followed up for an average of 10.4 years. Analyses were conducted on an intention-to-treat basis.


RESULTS
The 10-year survival was 71.0% for PTCA and 73.5% for CABG (p = 0.18). At 10 years, the PTCA group had substantially higher subsequent revascularization rates than the CABG group (76.8% vs. 20.3%, p < 0.001), but angina rates for the 2 groups were similar. In the subgroup of patients with no treated diabetes, survival rates were nearly identical by randomization (PTCA 77.0% vs. CABG 77.3%, p = 0.59). In the subgroup with treated diabetes, the CABG assigned group had higher survival than the PTCA assigned group (PTCA 45.5% vs. CABG 57.8%, p = 0.025).


CONCLUSIONS
There was no significant long-term disadvantage regarding mortality or myocardial infarction associated with an initial strategy of PTCA compared with CABG. Among patients with treated diabetes, CABG conferred long-term survival benefit, whereas the 2 initial strategies were equivalent regarding survival for patients without diabetes.
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology