Emory Angioplasty vs Surgery Trial - EAST

Jul 10, 2003
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Date Presented:
01/01/1994
Date Published:
01/01/1994
Date Updated:
07/10/2003
Original Posted Date:
07/10/2003
References

Description:

To compare outcomes of coronary artery bypass graft (CABG) surgery with percutaneous transluminal coronary angioplasty (PTCA) in patients with multivessel disease.

Hypothesis:

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.

Study Design

Study Design:

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)
Female: 26%
Mean Ejection Fraction: >25% (average 61%)

Patient Populations:

392 patients of any age with two-vessel or three-vessel CAD.

Exclusions:

Prior bypass surgery or coronary angioplasty, recent myocardial infarction (<5 days), old chronic occlusions (>8 weeks), left main stenosis >30%, and ejection fraction <25%.

Primary Endpoints:

Composite primary end point was death, Q-wave MI, and large defect on thallium scan at 3 years.

Secondary Endpoints:

ejection fraction, angina, and activity level

Drug/Procedures Used:

CABG surgery or PTCA

Principal Findings:

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.

Interpretation:

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.

References:

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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