title: Effect of complete revascularization on 10-year survival of patients with stable multivessel coronary artery disease: MASS II trial.
abstract: BACKGROUND
  The importance of complete revascularization remains unclear and contradictory. This current investigation compares the effect of complete revascularization on 10-year survival of patients with stable multivessel coronary artery disease (CAD) who were randomly assigned to percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).
  
  
  RESULTS
  This is a post hoc analysis of the Second Medicine, Angioplasty, or Surgery Study (MASS II), which is a randomized trial comparing treatments in patients with stable multivessel CAD, and preserved systolic ventricular function. We analyzed patients who underwent surgery (CABG) or stent angioplasty (PCI). The survival free of overall mortality of patients who underwent complete (CR) or incomplete revascularization (IR) was compared. Of the 408 patients randomly assigned to mechanical revascularization, 390 patients (95.6%) underwent the assigned treatment; complete revascularization was achieved in 224 patients (57.4%), 63.8% of those in the CABG group and 36.2% in the PCI group (P=0.001). The IR group had more prior myocardial infarction than the CR group (56.2% × 39.2%, P=0.01). During a 10-year follow-up, the survival free of cardiovascular mortality was significantly different among patients in the 2 groups (CR, 90.6% versus IR, 84.4%; P=0.04). This was mainly driven by an increased cardiovascular specific mortality in individuals with incomplete revascularization submitted to PCI (P=0.05).
  
  
  CONCLUSIONS
  Our study suggests that in 10-year follow-up, CR compared with IR was associated with reduced cardiovascular mortality, especially due to a higher increase in cardiovascular-specific mortality in individuals submitted to PCI.
  
  
  BACKGROUND
  URL: http://www.controlled-trials.com.
  
  
  BACKGROUND
  ISRCTN66068876.
authors.affiliation: Department of Atherosclerosis, Heart Institute of University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo D'Oliveira
authors.initials: RD
authors.lastname: Vieira
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.forename: Alexandre Costa
authors.initials: AC
authors.lastname: Pereira
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.forename: Alexandre Ciappina
authors.initials: AC
authors.lastname: Hueb
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.forename: Paulo Rogério
authors.initials: PR
authors.lastname: Soares
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000601:surgery* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome