Background: The clinical benefit of percutaneous transluminal coronary angioplasty (PTCA) as compared with coronary artery bypass grafting (CABG) for patients with multivessel coronary artery disease (CAD) has not been established. To determine the outcomes of these treatments in patients referred for the first time for coronary revascularization, we conducted a 5-year prospective trial comparing the two procedures.
Methods: From June 1989 to June 1993, a total of 1939 patients with multivessel coronary disease were screened at a single clinical site, and 152 patients (29%) were randomly assigned to undergo CABG (76 patients) or PTCA (76 patients). Enrollment required that complete revascularization of at least two major vessels supplying different myocardial regions be deemed clinically necessary and technically feasible.
Results: After PTCA or CABG, the clinical success rates were, respectively, 82.9 and 84.2%, whereas in-hospital mortality did not differ significantly between the two groups (1.3% in each group). At 5 years, the proportions of patients in the CABG group who required repeated bypass surgery (0%) or angioplasty (9%) were significantly lower than the proportions in the PTCA group (14.5 and 14.5%, P<.01). Event-free survival was higher in the surgery group (82.9%) than in the PTCA group (68.4%) (P<.05).
Conclusions: In a carefully selected population of patients with multivessel CAD, angioplasty may offer an effective alternative to bypass surgery. However, to achieve similar clinical outcomes, the patients treated with PTCA are more likely to require further interventions.