Document Detail

Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease.
MedLine Citation:
PMID:  17339566     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Despite routine use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), no conclusive evidence exists that either modality is superior to medical therapy (MT) alone for treating multivessel coronary artery disease with stable angina and preserved ventricular function. METHODS AND RESULTS: The primary end points were total mortality, Q-wave myocardial infarction, or refractory angina requiring revascularization. The study comprised 611 patients randomly assigned to undergo CABG (n=203), PCI (n=205), or MT (n=203). At the 5-year follow-up, the primary end points occurred in 21.2% of patients who underwent CABG compared with 32.7% treated with PCI and 36% receiving MT alone (P=0.0026). No statistical differences were observed in overall mortality among the 3 groups. In addition, 9.4% of MT and 11.2% of PCI patients underwent repeat revascularization procedures compared with 3.9% of CABG patients (P=0.021). Moreover, 15.3%, 11.2%, and 8.3% of patients experienced nonfatal myocardial infarction in the MT, PCI, and CABG groups, respectively (P<0.001). The pairwise treatment comparisons of the primary end points showed no difference between PCI and MT (relative risk, 0.93; 95% confidence interval, 0.67 to 1.30) and a significant protective effect of CABG compared with MT (relative risk, 0.53; 95% confidence interval, 0.36 to 0.77). CONCLUSIONS: All 3 treatment regimens yielded comparable, relatively low rates of death. MT was associated with an incidence of long-term events and rate of additional revascularization similar to those for PCI. CABG was superior to MT in terms of the primary end points, reaching a significant 44% reduction in primary end points at the 5-year follow-up of patients with stable multivessel coronary artery disease.
Whady Hueb; Neuza Helena Lopes; Bernard J Gersh; Paulo Soares; Luiz A C Machado; Fabio B Jatene; Sergio A Oliveira; Jose A F Ramires
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  115     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-06     Completed Date:  2007-03-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1082-9     Citation Subset:  AIM; IM    
Heart Institute of the University of São Paulo, São Paulo, Brazil.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Angina Pectoris / drug therapy,  surgery,  therapy
Angioplasty, Transluminal, Percutaneous Coronary* / statistics & numerical data
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Calcium Channel Blockers / therapeutic use
Cardiovascular Agents / therapeutic use*
Coronary Artery Bypass* / statistics & numerical data
Coronary Disease / diet therapy,  drug therapy,  mortality,  surgery,  therapy*
Coronary Restenosis / epidemiology,  surgery,  therapy
Diet, Fat-Restricted
Disease-Free Survival
Drug Therapy, Combination
Endpoint Determination
Follow-Up Studies
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Middle Aged
Myocardial Infarction / epidemiology,  etiology,  prevention & control
Nitrates / therapeutic use
Survival Analysis
Treatment Outcome
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Calcium Channel Blockers; 0/Cardiovascular Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Nitrates
Comment In:
Circulation. 2007 Mar 6;115(9):1064-6   [PMID:  17339563 ]

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