Angioplasty and bypass offer similar outcomes for high-risk cardiac patients

NEW YORK (Reuters Health) – Patients with medically refractory myocardial ischemia who are at high risk for adverse outcomes with bypass surgery, have similar 3-year survival rates after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG).

The finding is reported in the January 16th Journal of the American College of Cardiology, and comes from an analysis of data from the Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) trial. The study included a group of patients who were randomized to PCI or CABG, and another group that declined random allocation.

The randomized trial demonstrated comparable 3-year survival after either approach, at 79% and 80%. In the current paper, Dr. Douglass A. Morrison, from Tucson Veterans Affairs Medical Center in Tucson, Arizona, and colleagues, report on the outcomes of two patient registries that included those who opted out of randomization.

In the registry of patients who selected their own intervention, 31% chose CABG and 69% chose PCI, the authors report. In the registry that included those who followed their physician's recommendation, 52% underwent CABG and 48% received PCI.

Physicians were likely to recommend CABG for patients over 70 years of age with prior congestive heart failure, three-vessel disease, left main coronary artery stenosis more than 50%, and NYHA class III/IV disease, the report indicates. PCI was the more likely recommended for patients with prior PCI, prior CABG, prior MI, and disease in a saphenous vein graft.

Survival rates at 36 months for CABG and PCI were 80% and 89%, respectively, in the patient-choice subgroup, and 76% for both modalities in the physician-directed subgroup. The differences were not statistically significant.

"The AWESOME registry results extend the randomized trial conclusion that CABG and PCI are both options for medically refractory patients with angina having prior CABG, recent MI, poor left ventricular function, age >70 or instability necessitating intra-aortic balloon counterpulsation," the authors conclude.

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