| Native coronary disease progression exceeds failed revascularization as cause of angina after five years in the Bypass Angioplasty Revascularization Investigation (BARI). | |
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MedLine Citation:
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PMID: 15312856 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Coronary angiograms obtained five years following revascularization were examined to assess the extent of compromise in myocardial perfusion due to failure of revascularization versus progression of native disease. BACKGROUND: The Bypass Angioplasty Revascularization Investigation (BARI) randomized revascularization candidates between bypass surgery and angioplasty. Entry and five-year angiograms from 407 of 519 (78%) patients at four centers were analyzed. METHODS: Analysis of the distribution of coronary vessels and stenoses provided a measure of myocardial jeopardy that correlates with presence of angina. The extent to which initial benefits of revascularization were undone by failed revascularization versus native disease progression was assessed. RESULTS: Myocardial jeopardy fell following initial revascularization, from 60% to 17% for percutaneous coronary intervention (PCI)-treated patients compared with 60% to 7% for coronary artery bypass graft (CABG) surgery patients (p < 0.001), rebounding at five years to 25% for PCI and 20% for surgery patients (p = 0.01). Correspondingly, angina prevalence was higher at five years in PCI-treated patients than in surgery-treated patients (28% vs. 18%; p = 0.03). However, myocardial jeopardy at five years, and not initial treatment (PCI vs. surgery), was independently associated with late angina. Increased myocardial jeopardy from entry to five-year angiogram occurred in 42% of PCI-treated patients and 51% of CABG-treated patients (p = 0.06). Among the increases in myocardial jeopardy, two-thirds occurred in previously untreated arteries. CONCLUSIONS: Native coronary disease progression occurred more often than failed revascularization in both PCI- and CABG-treated patients as a cause of jeopardized myocardium and angina recurrence. These results support intensive postrevascularization risk-factor modification. |
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Authors:
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Edwin L Alderman; Kevin E Kip; Patrick L Whitlow; Thomas Bashore; Donald Fortin; Martial G Bourassa; Jacques Lesperance; Leonard Schwartz; Michael Stadius; |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 44 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2004 Aug |
Date Detail:
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Created Date: 2004-08-17 Completed Date: 2004-09-10 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 766-74 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Division, Stanford University, Stanford, California, USA. alderman@stanford.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angina Pectoris
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therapy Angioplasty, Transluminal, Percutaneous Coronary* California Coronary Angiography Coronary Artery Bypass* Coronary Artery Disease / radiography, therapy* Coronary Restenosis Disease Progression Female Humans Male Middle Aged North Carolina Ohio Pennsylvania Quebec Randomized Controlled Trials as Topic Treatment Failure Treatment Outcome Washington |
| Grant Support | |
ID/Acronym/Agency:
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HL51419/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2004 Aug 18;44(4):775-7
[PMID:
15312857
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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