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. 1998 Apr;168(4):280–285.

Revascularization in coronary artery disease. A review of randomized trial data.

C R Keenan 1, T M Chou 1
PMCID: PMC1304964  PMID: 9584677

Abstract

Since the advent of bypass surgery in the late 1960s and catheter-based intervention in the late 1970s, the treatment of coronary artery disease has been revolutionized by the concept of revascularization. Surveys have demonstrated that the practice patterns around the world and within the US are inconsistent for these important treatment options and are often driven by availability and economics rather than evidence-based data. In addition, the studies examining the use of medical therapy, balloon angioplasty, atherectomy, coronary stenting, and bypass surgery are consistently lagging behind the technological advances in this field. This article reviews the data that randomized trials and meta-analyses provide to compare these modalities. We attempt to provide a framework for reasoned clinical decision making to help guide patient care. While the breakpoints between the medicine bottle, cath lab, and operating room will continue to evolve, we offer a revascularization strategy for patient subgroups based on what clinical data supports.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderman E. L., Bourassa M. G., Cohen L. S., Davis K. B., Kaiser G. G., Killip T., Mock M. B., Pettinger M., Robertson T. L. Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study. Circulation. 1990 Nov;82(5):1629–1646. doi: 10.1161/01.cir.82.5.1629. [DOI] [PubMed] [Google Scholar]
  2. Cameron A., Davis K. B., Green G., Schaff H. V. Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period. N Engl J Med. 1996 Jan 25;334(4):216–219. doi: 10.1056/NEJM199601253340402. [DOI] [PubMed] [Google Scholar]
  3. Cohen D. J., Krumholz H. M., Sukin C. A., Ho K. K., Siegrist R. B., Cleman M., Heuser R. R., Brinker J. A., Moses J. W., Savage M. P. In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty. Results from a randomized clinical trial. Stent Restenosis Study Investigators. Circulation. 1995 Nov 1;92(9):2480–2487. doi: 10.1161/01.cir.92.9.2480. [DOI] [PubMed] [Google Scholar]
  4. Favaloro R. G. Saphenous vein autograft replacement of severe segmental coronary artery occlusion: operative technique. Ann Thorac Surg. 1968 Apr;5(4):334–339. doi: 10.1016/s0003-4975(10)66351-5. [DOI] [PubMed] [Google Scholar]
  5. Fischman D. L., Leon M. B., Baim D. S., Schatz R. A., Savage M. P., Penn I., Detre K., Veltri L., Ricci D., Nobuyoshi M. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994 Aug 25;331(8):496–501. doi: 10.1056/NEJM199408253310802. [DOI] [PubMed] [Google Scholar]
  6. Grüntzig A. R., Senning A., Siegenthaler W. E. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979 Jul 12;301(2):61–68. doi: 10.1056/NEJM197907123010201. [DOI] [PubMed] [Google Scholar]
  7. Hamm C. W., Reimers J., Ischinger T., Rupprecht H. J., Berger J., Bleifeld W. A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. German Angioplasty Bypass Surgery Investigation (GABI) N Engl J Med. 1994 Oct 20;331(16):1037–1043. doi: 10.1056/NEJM199410203311601. [DOI] [PubMed] [Google Scholar]
  8. Hueb W. A., Bellotti G., de Oliveira S. A., Arie S., de Albuquerque C. P., Jatene A. D., Pileggi F. The Medicine, Angioplasty or Surgery Study (MASS): a prospective, randomized trial of medical therapy, balloon angioplasty or bypass surgery for single proximal left anterior descending artery stenoses. J Am Coll Cardiol. 1995 Dec;26(7):1600–1605. doi: 10.1016/0735-1097(95)00384-3. [DOI] [PubMed] [Google Scholar]
  9. King S. B., 3rd, Lembo N. J., Weintraub W. S., Kosinski A. S., Barnhart H. X., Kutner M. H., Alazraki N. P., Guyton R. A., Zhao X. Q. A randomized trial comparing coronary angioplasty with coronary bypass surgery. Emory Angioplasty versus Surgery Trial (EAST) N Engl J Med. 1994 Oct 20;331(16):1044–1050. doi: 10.1056/NEJM199410203311602. [DOI] [PubMed] [Google Scholar]
  10. Kloster F. E., Kremkau E. L., Ritzmann L. W., Rahimtoola S. H., Rösch J., Kanarek P. H. Coronary bypass for stable angina: a prospective randomized study. N Engl J Med. 1979 Jan 25;300(4):149–157. doi: 10.1056/NEJM197901253000401. [DOI] [PubMed] [Google Scholar]
  11. Macaya C., Serruys P. W., Ruygrok P., Suryapranata H., Mast G., Klugmann S., Urban P., den Heijer P., Koch K., Simon R. Continued benefit of coronary stenting versus balloon angioplasty: one-year clinical follow-up of Benestent trial. Benestent Study Group. J Am Coll Cardiol. 1996 Feb;27(2):255–261. doi: 10.1016/0735-1097(95)00473-4. [DOI] [PubMed] [Google Scholar]
  12. Mathur V. S., Guinn G. A. Prospective randomized study of the surgical therapy of stable angina. Cardiovasc Clin. 1977;8(2):131–144. [PubMed] [Google Scholar]
  13. Norris R. M., Agnew T. M., Brandt P. W., Graham K. J., Hill D. G., Kerr A. R., Lowe J. B., Roche A. H., Whitlock R. M., Barratt-Boyes B. G. Coronary surgery after recurrent myocardial infarction: progress of a trial comparing surgical with nonsurgical management for asymptomatic patients with advanced coronary disease. Circulation. 1981 Apr;63(4):785–792. doi: 10.1161/01.cir.63.4.785. [DOI] [PubMed] [Google Scholar]
  14. Nwasokwa O. N. Coronary artery bypass graft disease. Ann Intern Med. 1995 Oct 1;123(7):528–545. doi: 10.7326/0003-4819-123-7-199510010-00009. [DOI] [PubMed] [Google Scholar]
  15. Parisi A. F., Folland E. D., Hartigan P. A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators. N Engl J Med. 1992 Jan 2;326(1):10–16. doi: 10.1056/NEJM199201023260102. [DOI] [PubMed] [Google Scholar]
  16. Peduzzi P., Detre K., Murphy M. L., Thomsen J., Hultgren H., Takaro T. Ten-year incidence of myocardial infarction and prognosis after infarction. Department of Veterans Affairs Cooperative Study of Coronary Artery Bypass Surgery. Circulation. 1991 Mar;83(3):747–755. doi: 10.1161/01.cir.83.3.747. [DOI] [PubMed] [Google Scholar]
  17. Rodriguez A., Mele E., Peyregne E., Bullon F., Perez-Baliño N., Liprandi M. I., Palacios I. F. Three-year follow-up of the Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI). J Am Coll Cardiol. 1996 Apr;27(5):1178–1184. doi: 10.1016/0735-1097(95)00592-7. [DOI] [PubMed] [Google Scholar]
  18. Schömig A., Neumann F. J., Kastrati A., Schühlen H., Blasini R., Hadamitzky M., Walter H., Zitzmann-Roth E. M., Richardt G., Alt E. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med. 1996 Apr 25;334(17):1084–1089. doi: 10.1056/NEJM199604253341702. [DOI] [PubMed] [Google Scholar]
  19. Serruys P. W., Emanuelsson H., van der Giessen W., Lunn A. C., Kiemeney F., Macaya C., Rutsch W., Heyndrickx G., Suryapranata H., Legrand V. Heparin-coated Palmaz-Schatz stents in human coronary arteries. Early outcome of the Benestent-II Pilot Study. Circulation. 1996 Feb 1;93(3):412–422. doi: 10.1161/01.cir.93.3.412. [DOI] [PubMed] [Google Scholar]
  20. Serruys P. W., de Jaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994 Aug 25;331(8):489–495. doi: 10.1056/NEJM199408253310801. [DOI] [PubMed] [Google Scholar]
  21. Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988 Aug 11;319(6):332–337. doi: 10.1056/NEJM198808113190603. [DOI] [PubMed] [Google Scholar]
  22. Weintraub W. S., Mauldin P. D., Becker E., Kosinski A. S., King S. B., 3rd A comparison of the costs of and quality of life after coronary angioplasty or coronary surgery for multivessel coronary artery disease. Results from the Emory Angioplasty Versus Surgery Trial (EAST). Circulation. 1995 Nov 15;92(10):2831–2840. doi: 10.1161/01.cir.92.10.2831. [DOI] [PubMed] [Google Scholar]
  23. Yusuf S., Zucker D., Peduzzi P., Fisher L. D., Takaro T., Kennedy J. W., Davis K., Killip T., Passamani E., Norris R. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994 Aug 27;344(8922):563–570. doi: 10.1016/s0140-6736(94)91963-1. [DOI] [PubMed] [Google Scholar]

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