JAMA. 1997 Mar 5;277(9):715-21.
To compare clinical and functional status in patients who had similar 5-year survival after coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA).
Randomized trial of 1829 patients followed for an average 5.4 years.
Patients with multivessel coronary artery disease suitable for both CABG and PTCA and not previously revascularized.
Coronary artery bypass grafting or PTCA within 2 weeks after randomization.
Symptoms, exercise test results, medication use, and quality-of-life measures collected at 4 to 14 weeks, and at 1, 3, and 5 years after randomization.
Intention to treat.
Differences in angina-free rates between patients assigned to PTCA and CABG decreased from 73% vs 95% at 4 to 14 weeks (P<.001) to 79% vs 85% at 5 years (P=.007). Similar patterns were observed for exercise-induced angina and ischemia, except 5-year differences were not significant. At follow-up of 1 year and later, quality of life, return to work, modification of smoking and exercise behaviors, and cholesterol levels were similar for the 2 treatments. Compared with patients assigned to CABG, use of anti-ischemic medication was higher in patients assigned to PTCA, while smaller differences were observed for other medications. Among patients angina-free at 5 years, 52% of patients who had PTCA required revascularization after the initial procedure vs 6% of patients who had CABG.
The narrowing of treatment differences in angina and exercise-induced ischemia rates can be attributed to a return of symptoms among patients assigned to CABG and incremental surgical procedures among patients assigned to PTCA. Patients assigned to PTCA apparently were able to tolerate higher rates of residual ischemia as evidenced by comparable quality of life and 5-year survival.
比较冠状动脉旁路移植术（CABG）和经皮腔内冠状动脉成形术（PTCA）后5年生存率相似的患者的临床和功能状态。
对1829例患者进行平均5.4年随访的随机试验。
适合CABG和PTCA且此前未进行过血运重建的多支冠状动脉疾病患者。
随机分组后2周内进行冠状动脉旁路移植术或PTCA。
在随机分组后4至14周、1年、3年和5年收集症状、运动试验结果、药物使用情况和生活质量指标。
意向性分析。
分配接受PTCA和CABG的患者之间无心绞痛发生率的差异从4至14周时的73%对95%（P<0.001）降至5年时的79%对85%（P=0.007）。运动诱发的心绞痛和缺血也观察到类似模式，只是5年时的差异不显著。在1年及以后的随访中，两种治疗的生活质量、恢复工作情况、吸烟和运动行为的改变以及胆固醇水平相似。与分配接受CABG的患者相比，分配接受PTCA的患者使用抗缺血药物的比例更高，而其他药物的差异较小。在5年时无心绞痛的患者中，接受PTCA的患者中有52%在初次手术后需要进行血运重建，而接受CABG的患者中这一比例为6%。
心绞痛和运动诱发缺血率治疗差异的缩小可归因于接受CABG的患者症状复发以及接受PTCA的患者进行了额外的手术。分配接受PTCA的患者显然能够耐受更高的残余缺血率，这从相当的生活质量和5年生存率得到证明。
