Emory Angioplasty vs Surgery Trial - EAST
To compare outcomes of coronary artery bypass graft (CABG) surgery with percutaneous transluminal coronary angioplasty (PTCA) in patients with multivessel disease.
In patients with 2-vessel or 3-vessel coronary artery disease but no left main disease or severely depressed ejection fraction (<25%),PTCA would have a similar mortality compared to CABG surgery.
Patients Screened: 5118
Patients Enrolled: 392
NYHA Class: No restriction.
Mean Follow Up: 3 yr clinical follow-up. Rpeat angiography and thallium scan after 1 and 3 yrs
Mean Patient Age: 18+ (average 62 years)
Mean Ejection Fraction: >25% (average 61%)
392 patients of any age with two-vessel or three-vessel CAD.
Prior bypass surgery or coronary angioplasty, recent myocardial infarction (<5 days), old chronic occlusions (>8 weeks), left main stenosis >30%, and ejection fraction <25%.
Composite primary end point was death, Q-wave MI, and large defect on thallium scan at 3 years.
ejection fraction, angina, and activity level
CABG surgery or PTCA
No significant difference was observed between groups in 3-year mortality (7.1% vs. 6.3%) or primary composite end point consisting of death, Q-wave MI, and large defect on thallium scan at 3 years (28.8% vs. 27.3%). The CABG group had lower rates of repeat coronary artery bypass surgery (1% vs. 22%; p < 0.001) and fewer repeat angioplasties (13% vs. 41%; p < 0.001) and also reported less angina (12% vs. 20%). At eight years, mortality rates still did not significantly differ between groups.
In stable patients with multivessel CAD, there is no mortality difference between CABG and PTCA. However, CABG was associated with fewer repeat interventions and better quality of life.
N Engl J Med 1994;331:1044–50. Principal results. J Am Coll Cardiol 2000; 35: 1116-21. 8 yr data. Related trials: BARI, CABRI, ERACI, GABI, RITA
Keywords: Coronary Artery Disease, Quality of Life, Coronary Artery Bypass, Angioplasty, Balloon, Coronary
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