Document Detail


Percutaneous coronary intervention versus coronary bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: The VA AWESOME multicenter registry: comparison with the randomized clinical trial.
MedLine Citation:
PMID:  11788218     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study was designed to compare the three-year survival after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) in physician-directed and patient-choice registries with the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) randomized trial results. BACKGROUND: The AWESOME multicenter randomized trial and registry compared the long-term survival after PCI and CABG for the treatment of patients with medically refractory myocardial ischemia and at least one additional risk factor for adverse outcome with CABG. The randomized trial demonstrated comparable three-year survival. METHODS: Over a five-year period (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of five risk factors (prior heart surgery, myocardial infarction within seven days, left ventricular ejection fraction <0.35, age >70 years, intra-aortic balloon required to stabilize) were identified. By physician consensus, 1,650 patients formed a physician-directed registry assigned to CABG (692), PCI (651) or further medical therapy (307), and 781 were angiographically eligible for random allocation; 454 of these patients constitute the randomized trial, and the remaining 327 constitute a patient choice registry. Survival for CABG and PCI was compared using Kaplan-Meier curves and log-rank tests. RESULTS: The CABG and PCI 36-month survival rates for randomized patients were 79% and 80%, respectively. The CABG and PCI 36-month survival rates were both 76% for the physician-directed subgroup; comparable survival rates for the patient-choice subgroup were 80% and 89%, respectively. None of the global log-rank tests for survival demonstrated significant differences. CONCLUSIONS: Both registries support the randomized trial conclusion: PCI is an alternative to CABG for some medically refractory high-risk patients.
Authors:
Douglass A Morrison; Gulshan Sethi; Jerome Sacks; William Henderson; Frederick Grover; Steven Sedlis; Rick Esposito; Kodagundi B Ramanathan; Darryl Weiman; J David Talley; Jorge Saucedo; Tamim Antakli; Venki Paramesh; Stuart Pett; Sarah Vernon; Vladimir Birjiniuk; Frederick Welt; Mitchell Krucoff; Walter Wolfe; John C Lucke; Sundeep Mediratta; David Booth; Charles Barbiere; Dan Lewis;
Related Documents :
7955238 - Preoperative determinants of postoperative costs associated with coronary artery bypass...
18396798 - Effect of ala16val genetic polymorphism of mnsod on antioxidant capacity and inflammato...
18069678 - Paradoxical septal motion after cardiac surgery: a review of 3,292 cases.
12440608 - Sustained increases of plasma homocysteine, copper, and serum ceruloplasmin after coron...
2039668 - Oxygen free radicals and congestive heart failure.
6605798 - Non-cardiac surgery in patients with prior myocardial revascularization.
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  39     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-14     Completed Date:  2002-02-01     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:  266-73     Citation Subset:  AIM; IM    
Affiliation:
Cardiac Catheterization Laboratory, Tucson VA Medical Center, Tucson, Arizona 85723, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Artery Bypass*
Humans
Middle Aged
Myocardial Ischemia / mortality*,  surgery,  therapy*
Randomized Controlled Trials as Topic
Registries
Treatment Outcome

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


Previous Document:  Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the ...
Next Document:  Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and pr...