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Ann Thorac Surg 1989;47:507-516
© 1989 The Society of Thoracic Surgeons

Articles

Comparison of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty as initial treatment strategies

Cary W. Akins, MD*,a,b, Peter C. Block, MDa,b, Igor F. Palacios, MDa,b, Herman K. Gold, MDa,b, Diane L. Carroll, MSNa,b, Gary L. Grunkemeier, PhDa,b

a Departments of Mediane and Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
b Data Research Department, St. Vincent Hospital and Medical Center, Portland, Oregon, USA

* Address reprint requests to Dr Akins, Department of Surgery, Massachusetts General Hospital, Fruit St. Boston, MA 02114.

Early and late resulte of primary nonemergency coronary artery bypass grafting in 1,000 consecutive patients and primary nonemergency percutaneous transluminal coronary angioplasty performed concurrently in 389 patients were retrospectively compared. The coronary bypass population was significantly older and more symptomatic and had more prior myocardial infarctions, more left main and multiple-vessel coronary artery disease, and poorer ventricular function. Hospital mortality rates for coronary bypass grafting and angioplasty were 0.4% and 0.5%, respectively, and infarction rates were 1.7% and 5.1%, respectively (p < 0.01). Including hospital events for the coronary bypass and angioplasty populations, actuarial survival at 5 years was 92.3% versus 96.3% (p = 0.04), freedom from myocardial infarction was 94.6% versos 88.1% (p < 0.061), freedom from subsequent angioplasty was 99.5% versos 75.2% (p < 0.001), freedom from subsequent coronary bypass grafting was 98.8% versus 84.9% (p < 0.001), and freedom from all morbidity and mortality was 87.1% versus 66.0% (p < 0.001), respectively. By Cox regression analysis for all 1,389 patients, only diminished ejection fraction and advanced age predicted poor long-term survival (p < 0.001). The only significant predictor of nonfatal late events was having had coronary angioplasty.




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