HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Charles J. Mullany Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mullany, C. J. Articles by Frye, R. L. Search for Related Content PubMed PubMed Citation Articles by Mullany, C. J. Articles by Frye, R. L.

Ann Thorac Surg 1999;67:396-403
© 1999 The Society of Thoracic Surgeons

---

Original Articles

Effect of age in the bypass angioplasty revascularization investigation (BARI) randomized trial

^a Mayo Clinic, Rochester, Minnesota, USA
^b Bellevue Hospital, New York, New York, USA
^c University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Accepted for publication June 27, 1998.

Address reprint requests to Dr Detre, BARI Coordinating Center, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St, Pittsburgh, PA 15261
e-mail: cmullany{at}mayo.edu

Background. The influence of age on the relative success of either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) in patients requiring myocardial revascularization continues to be controversial.

Methods. In the Bypass Angioplasty Revascularization Investigation (BARI) trial, 1,829 patients with symptomatic multivessel coronary artery disease requiring revascularization were randomly assigned to undergo either CABG or PTCA.

Results. Seven hundred nine patients (39%) were 65 to 80 years old at baseline; the other 1,120 were younger than 65 years. The in-hospital 30-day mortality rate for PTCA and CABG in the younger patients was 0.7% and 1.1%, respectively, and that for patients 65 years or older was 1.7% and 1.7%, respectively. In older compared with younger patients, stroke was more common after CABG (1.7% versus 0.2%, p = 0.015) and heart failure or pulmonary edema was more common after PTCA (4.0 versus 1.3%, p = 0.011). In both age groups, CABG resulted in greater relief of angina and fewer repeat procedures. The 5-year survival rate in patients younger than 65 years was 91.5% for CABG and 89.5% for PTCA. In patients 65 years or older, the 5-year survival rate was 85.7% for CABG and 81.4% for PTCA. Cardiac mortality at 5 years was greater in patients assigned to the PTCA group than in those assigned to the CABG group. However, no significant treatment differences were noted in cardiac mortality when only nondiabetic patients were examined.

Conclusions. Within the context of the Bypass Angioplasty Revascularization Investigation trial, older patients with multivessel coronary disease do well with either PTCA or CABG. Compared with younger patients, older patients had less recurrent angina and were less likely to undergo repeat procedures, particularly among those assigned to undergo CABG. Cardiac mortality was greater in patients 65 years or older assigned to undergo PTCA; however, this difference was not noted when treated diabetic patients were excluded from analysis.

This article has been cited by other articles:

				M. A. Albert, N. Halevy, and E. M. Antman Preoperative Evaluation for Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 261 - 280. [Full Text]

				D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]

				K. B. Ramanathan, D. S. Weiman, J. Sacks, D. A. Morrison, S. Sedlis, G. Sethi, and W. G. Henderson Percutaneous Intervention Versus Coronary Bypass Surgery for Patients Older Than 70 Years of Age With High-Risk Unstable Angina Ann. Thorac. Surg., October 1, 2005; 80(4): 1340 - 1346. [Abstract] [Full Text] [PDF]

				M. A. Albert and E. M. Antman Preoperative Evaluation for Cardiac Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 235 - 248. [Full Text]

				Z. S Meharwal and N. Trehan Off-Pump Coronary Artery Surgery in the Elderly Asian Cardiovasc Thorac Ann, September 1, 2002; 10(3): 206 - 210. [Abstract] [Full Text] [PDF]

				S. C. Stamou and P. J. Corso Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future Ann. Thorac. Surg., March 1, 2001; 71(3): 1056 - 1061. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, D. D. Miller, P. Liu, P. Guo, M. M. Brooks, and M. Schwaiger Similarity of Ventricular Function in Patients Alive 5 Years After Randomization to Surgery or Angioplasty in the BARI Trial Circulation, February 27, 2001; 103(8): 1076 - 1082. [Abstract] [Full Text] [PDF]

				J. Kilo, H. Baumer, M. Czerny, M. J. Hiesmayr, M. Ploner, E. Wolner, and M. Grimm Target vessel revascularization without cardiopulmonary bypass in elderly high-risk patients Ann. Thorac. Surg., February 1, 2001; 71(2): 537 - 542. [Abstract] [Full Text] [PDF]

				A. P. C. Yim, A. A Arifi, and S. Wan Coronary Artery Bypass Grafting in the Elderly : The Challenge and the Opportunity Chest, May 1, 2000; 117(5): 1220 - 1221. [Full Text] [PDF]