Long term results of different strategies with multivessel CAD

January 01, 0001

Long term results of different strategies with multivessel CAD

These Brazilian and US researchers compared the 10-year follow-up of percutaneous coronary intervention (PCI), coronary artery surgery (CABG), and medical treatment (MT) in patients with multivessel coronary artery disease, stable angina, and preserved ventricular function. Patients (n=611) were recruited from a single institution and randomly assigned to one of three arms, those arms being CABG (n=203), PCI (n=205), or MT (n=203).

The researchers found: "The 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69% with MT. The 10-year rates of myocardial infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT. The 10- year rates of additional revascularizations were 7.4% with CABG, 41.9% with PCI, and 39.4% with MT. Relative to the composite end point, Cox regression analysis showed a higher incidence of primary events in MT than in CABG (hazard ratio 2.35) and in PCI than in CABG (hazard ratio 1.85). Furthermore, 10-year rates of freedom from angina were 64% with CABG, 59% with PCI, and 43% with MT."

The researchers concluded: "Compared with CABG, MT was associated with a significantly higher incidence of subsequent myocardial infarction, a higher rate of additional revascularization, a higher incidence of cardiac death, and consequently a 2.29-fold increased risk of combined events. PCI was associated with an increased need for further revascularization, a higher incidence of myocardial infarction, and a 1.46-fold increased risk of combined events compared with CABG. Additionally, CABG was better than MT at eliminating anginal symptoms."

This study provided important evidence upon which patients and physicians can base decisions regarding treat of multivessel coronary artery disease.

For the full abstract, click here.

Circulation 122(10):949-957, 7 September 2007
© 2010 American Heart Association
Ten-Year Follow-Up Survival of the Medicine, Angioplasty, or Surgery Study (MASS II): A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease. Whady Hueb, Neuza Lopes, Bernard J. Gersh, et al.

Category: K. Circulatory. Keywords: CAD, CABG, stent, medical therapy, MASS II, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 24 September 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.