Botas J, Stadius M L, Bourassa M G, Rosen A D, Schaff H V, Sopko G, Williams D O, McMilliam A, Alderman E L
The Division of Cardiovascular Medicine, CVRB, Stanford University Medical Center, California, USA.
Am J Cardiol. 1996 Apr 15;77(10):805-14. doi: 10.1016/s0002-9149(97)89173-4.
The Bypass Angioplasty Revascularization Investigation (BARI) randomized 1,829 patients to percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). Clinical site angiographers categorized lesions of > or = 50% diameter stenosis (n = 4,977) as clinically significant (86.4%) or nonsignificant (13.6%), and as favorable or nonfavorable for PTCA or CABG. More lesions were considered favorable for revascularization by CABG than by PTCA (91.5% vs 78.4%; p <0.001), particularly in the subgroup of 99% to 100% lesions (77.6% for CABG vs 21.9% for PTCA, p <0.001). Lesion features, characterized by the BARI core laboratory, were correlated with clinical site angiographers' assessment of clinical importance and suitability for PTCA or CABG. By multivariate analysis, positive predictors of clinical importance for 50% to 95% stenoses were greater stenosis severity, more jeopardized myocardium, larger reference diameter, and proximal vessel location. For 99% to 100% occlusions, predictors were shorter duration of occlusion and more jeopardized myocardium. PTCA suitability for 50% to 95% stenoses was inversely related to lesion length, ostial location, location on a bend, difficult access, and age, and was directly associated with greater Thrombolysis in Myocardial Infarction (TIMI) trial flow rate and more jeopardized myocardium. Predictors of PTCA suitability for 99% to 100% lesions were a lower American College of Cardiology/American Heart Association class and higher TIMI grade. Predictors for 50% to 95% stenoses were more jeopardized myocardium, larger reference diameter, and more proximal vessel location, and for 99% to 100% occlusions, more jeopardized myocardium and shorter duration of occlusion. Suitability for PTCA depended on lesion potency (<99%) and multiple morphologic characteristics that contrasted with the few angiographic features that adversely affect CABG suitability.
旁路血管成形术血运重建研究（BARI）将1829例患者随机分为经皮腔内冠状动脉成形术（PTCA）组或冠状动脉旁路移植术（CABG）组。临床现场血管造影师将直径狭窄≥50%的病变（n = 4977）分类为具有临床意义（86.4%）或无临床意义（13.6%），并根据病变对PTCA或CABG是否有利进行分类。与PTCA相比，更多病变被认为通过CABG进行血运重建更有利（91.5%对78.4%；p<0.001），尤其是在99%至100%病变亚组中（CABG为77.6%，PTCA为21.9%，p<0.001）。由BARI核心实验室确定的病变特征与临床现场血管造影师对临床重要性以及对PTCA或CABG适用性的评估相关。通过多变量分析，50%至95%狭窄病变临床重要性的阳性预测因素包括更高的狭窄严重程度、更多受危及的心肌、更大的参考直径以及近端血管位置。对于99%至100%闭塞病变，预测因素为更短的闭塞持续时间和更多受危及的心肌。50%至95%狭窄病变对PTCA的适用性与病变长度、开口位置、弯曲处位置、入路困难程度以及年龄呈负相关，与心肌梗死溶栓（TIMI）试验血流率更高以及更多受危及的心肌呈正相关。99%至100%病变对PTCA适用性的预测因素为较低的美国心脏病学会/美国心脏协会分级和更高的TIMI分级。50%至95%狭窄病变的预测因素为更多受危及的心肌、更大的参考直径以及更近端的血管位置，而99%至100%闭塞病变的预测因素为更多受危及的心肌和更短的闭塞持续时间。PTCA的适用性取决于病变程度（<99%）以及多种形态学特征，这与少数对CABG适用性有不利影响的血管造影特征形成对比。
