Seven-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI) by treatment and diabetic status
Key result
CABG improves 7-year survival by ~3.5 percentage points over PTCA, driven largely by diabetic patients.
- P=0.043
- n=1,829
Why the study?
The primary five-year BARI results showed no overall survival difference between CABG and PTCA, but a subgroup of treated diabetic patients showed a survival benefit with CABG that was not specified a priori.
Does CABG improve seven-year survival compared to PTCA in symptomatic patients with multivessel disease?
Study Design
Type
RCT (n=1,829)
Structured PICO
Does CABG improve seven-year survival compared to PTCA in symptomatic patients with multivessel disease?
P
Population
1,829 symptomatic patients with multivessel disease randomly assigned to CABG or PTCA, followed for an average of 7.8 years.
I
Intervention
Coronary artery bypass grafting (CABG)
C
Comparator
Percutaneous transluminal coronary angioplasty (PTCA)
O
Outcome
Seven-year survivalhard clinical
Main Result
Absolute Event Rate: 84.4% vs 80.9%
p-value: p=0.043
Limitations
- Diabetic subgroup analysis was not specified a priori
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Bypass surgery's protective effect for diabetic patients who have subsequent heart attacks helps to explain why bypass patients were experiencing dramatically lower seven-year death rates than those patients who had undergone angioplasty.”
“Our long-term data show that a history of diabetes holds a similar risk for both angioplasty and bypass patients. Rather than using diabetes to determine the revascularization choice, other factors should be considered, such as disease severity and technical considerations.”
“CABG first emerged as the preferred treatment for diabetics in the BARI trial.”
Implication
CABG provides a statistically significant long-term survival advantage over PTCA at seven years in patients with multivessel disease, which is driven entirely by the pronounced benefit seen in patients with treated diabetes mellitus.
Abstract
OBJECTIVES: To compare seven-year survival in the Bypass Angioplasty Revascularization Investigation (BARI) patients randomly assigned to percutaneous transluminal coronary angioplasty (PTCA) versus coronary artery bypass grafting (CABG). BACKGROUND: The primary results of BARI reported no significant difference in five-year survival between CABG and PTCA groups. However, among patients with treated diabetes mellitus, a subgroup not specified a priori, a striking difference was seen in favor of CABG. METHODS: Symptomatic patients with multivessel disease (n = 1,829) were randomly assigned to initial treatment strategy of CABG or PTCA and followed for an average of 7.8 years. The intention-to-treat principle was used to extend the initial five-year BARI treatment comparisons. RESULTS: Kaplan-Meier estimates of seven-year survival for the total population were 84.4% for CABG and 80.9% for PTCA (p = 0.043). This difference could be explained by the 353 patients with treated diabetes mellitus for whom estimates of seven year survival were 76.4% CABG and 55.7% PTCA (p = 0.0011). Among the remaining 1,476 patients without treated diabetes, survival was virtually identical by assigned treatment (86.4% CABG, 86.8% PTCA, p = 0.72). The PTCA group had substantially higher subsequent revascularization rates than the CABG group (59.7% vs. 13.1%, p < 0.001); however, the changes between the five- and seven-year rates were similar for the two groups. CONCLUSIONS: At seven years, there was a statistically significant survival advantage for patients randomized to CABG compared with PTCA. Among patients with treated diabetes mellitus, the benefit of CABG over PTCA seen at five years was more pronounced at seven years; among nondiabetic patients, there was essentially no treatment difference.
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Cite This Study
A 2000 study conducted an RCT in Symptomatic multivessel coronary disease (n=1,829). Coronary artery bypass grafting (CABG) vs. Percutaneous transluminal coronary angioplasty (PTCA) was evaluated on Seven-year survival (p=0.043). Coronary artery bypass grafting (CABG) resulted in significantly higher seven-year survival compared to PTCA (84.4% vs 80.9%, P=0.043), particularly among patients with treated diabetes mellitus.