Detre K M, Rosen A D, Bost J E, Cooper M E, Sutton-Tyrrell K, Holubkov R, Shemin R J, Frye R L
Department of Epidemiology, University of Pittsburgh, Pennsytvania 15261, USA.
J Am Coll Cardiol. 1996 Sep;28(3):609-15. doi: 10.1016/0735-1097(96)00216-1.
To assess generalizability of the Bypass Angioplasty Revascularization Investigation (BARI), we conducted a separate study comparing revascularization in U.S. and BARI hospitals.
The BARI trial is a multicenter investigation comparing initial revascularization with percutaneous transluminal coronary angioplasty and coronary bypass graft surgery in patients with symptomatic multivessel coronary disease.
All revascularization procedures during 5 consecutive workdays were surveyed at 75 U.S. hospitals offering coronary angioplasty and bypass surgery and at all BARI hospitals. Data collected were demographics, extent of disease and type of current and previous revascularization.
At both U.S. and BARI hospitals, 57% of all revascularization procedures were coronary angioplasty and 43% were bypass surgery. The U.S. hospitals had more patients with single-vessel disease, acute myocardial infarction and primary procedures. Other characteristics were similar. The majority of revascularization procedures were angioplasty for single-vessel disease (U.S. 32% vs. BARI 25%) and bypass surgery for triple-vessel disease (U.S. 31% vs. BARI 31%). Overall, the choice between bypass surgery and angioplasty was similar in BARI and U.S. hospitals (adjusted odds ratio [OR] 1.0, p = 0.914). However, older patients were more likely and younger patients less likely to undergo bypass surgery in BARI versus U.S. hospitals (older patients: adjusted OR 1.6, p = 0.031; younger patients: adjusted OR 0.6, p = 0.028). The BARI protocol would have excluded 65% of all candidates for revascularization, for whom indications already exist for angioplasty or bypass surgery, and another 23%, for whom angioplasty would be contraindicated for individual lesions.
Patients undergoing coronary revascularization in BARI and U.S. hospitals were generally similar, as was the choice between types of revascularization. Results from the BARI trial apply to approximately 300 (12%) candidates for coronary revascularization/workday.
为评估“搭桥血管成形术血运重建研究（BARI）”的普遍性，我们开展了一项单独研究，比较美国医院和参与BARI研究的医院的血运重建情况。
BARI试验是一项多中心研究，比较症状性多支冠状动脉疾病患者经皮腔内冠状动脉成形术和冠状动脉搭桥手术两种初始血运重建方式。
对提供冠状动脉成形术和搭桥手术的75家美国医院以及所有参与BARI研究的医院连续5个工作日内的所有血运重建手术进行了调查。收集的数据包括人口统计学资料、疾病程度以及当前和既往血运重建的类型。
在美国医院和参与BARI研究的医院，所有血运重建手术中57%为冠状动脉成形术，43%为搭桥手术。美国医院中单支血管病变、急性心肌梗死和初次手术的患者更多。其他特征相似。大多数血运重建手术为单支血管病变的成形术（美国为32%，BARI为25%）和三支血管病变的搭桥手术（美国为31%，BARI为31%）。总体而言，BARI研究中的医院和美国医院在搭桥手术和成形术之间的选择相似（校正比值比[OR]为1.0，p = 0.914）。然而，与美国医院相比，BARI研究中的医院老年患者接受搭桥手术的可能性更大，而年轻患者接受搭桥手术的可能性更小（老年患者：校正OR为1.6，p = 0.031；年轻患者：校正OR为0.6，p = 0.028）。BARI研究方案会排除所有血运重建候选者中的65%，这些患者已经有进行成形术或搭桥手术的指征，另外还会排除23%，这些患者因个体病变而行成形术会有禁忌。
在美国医院和参与BARI研究的医院接受冠状动脉血运重建的患者总体相似，血运重建类型之间的选择也是如此。BARI试验的结果适用于大约300名（12%）冠状动脉血运重建候选者/工作日。
