[Comparison between PTCA and bypass operation. Results of large randomized studies].

BACKGROUND

The percutaneous transluminal coronary angioplasty (PTCA) and the coronary artery bypass surgery (CABG) are established therapy modalities for the coronary artery disease. Meanwhile, first results of randomized trials comparing both therapy forms have been published.

PATIENTS AND METHODS

The results of the 6 large randomized trials (GABI, RITA CABRI, BARI, EAST, and ERACI) were compared and summarized. Inclusion criterium was coronary multivessel disease (in RITA also one-vessel-disease). Patients with left main stem stenosis, previous PTCA or CABG, severely depressed ejection fraction and total coronary occlusions were excluded in most trials. Between 127 and 1829 patients were randomized. Follow-up was 1 to 5 years.

RESULTS

There was no significant difference in mortality between the PTCA and the CABG-group, except in the diabetic patients of the BARI trial, who showed a significantly better survival after CABG. Mortality was 3 to 7% in most trials. The rate of myocardial infarction in the follow-up did not differ significantly. The prevalence of angina was higher in the PTCA-group in the first months after the procedure, but the difference became less marked during the follow-up. One year after the procedure, approximately 75% of the patients in the CABG-group and 70% in the PTCA-group were free from angina. The rate of additional revascularization procedures was significantly higher in the PTCA-group (32 to 54%) than in the CABG-group (3.2 to 13%). Treatment costs were significantly higher in the CABG-group.

CONCLUSION

Both therapy forms were very effective concerning treatment of angina without a significant difference in mortality or frequency of myocardial infarction. The PTCA patients required more revascularization procedures, the costs for their treatment were lower than in the CABG-group. The question, whether coronary stent implantation will influence these conclusions significantly, remains open.