Document Detail

Native coronary disease progression exceeds failed revascularization as cause of angina after five years in the Bypass Angioplasty Revascularization Investigation (BARI).
MedLine Citation:
PMID:  15312856     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
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:
Created Date:  2004-08-17     Completed Date:  2004-09-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  766-74     Citation Subset:  AIM; IM    
Cardiovascular Division, Stanford University, Stanford, California, USA.
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MeSH Terms
Angina Pectoris / therapy
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography
Coronary Artery Bypass*
Coronary Artery Disease / radiography,  therapy*
Coronary Restenosis
Disease Progression
Middle Aged
North Carolina
Randomized Controlled Trials as Topic
Treatment Failure
Treatment Outcome
Grant Support
Comment In:
J Am Coll Cardiol. 2004 Aug 18;44(4):775-7   [PMID:  15312857 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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