The purpose of this study is to evaluate the long-term outcome of patients with multivessel coronary artery disease who underwent percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft surgery (CABG) five years previous. The application of mechanical therapy for severe coronary artery disease (CAD) has increased substantially in the past decade. In 1988 in the U.S., approximately 250,000 patients with coronary artery disease were treated with percutaneous transluminal coronary angioplasty (PTCA) and nearly as many patients received coronary artery bypass graft (CABG) surgery (National Center for Health Statistics, 1988). Both methods provide relief from severe angina but the relative indications for PTCA and CABG in patients with multivessel coronary artery disease is unclear. PTCA is less invasive but in patients with more advanced multivessel disease, it appears to have complication rates comparable to those of CABG. Early restenosis necessitates an additional procedure within 6 months in over 30% of the patients who undergo PTCA. Before informed therapeutic choices can be made between the two procedures, controlled studies are needed to compare objectively the benefits and risks of an initial strategy of PTCA versus CABG. The Bypass Angioplasty Revascularization (BARI) was designed to compare these strategies and provide scientific evidence upon which patients and physicians could base decisions for choosing one or the other therapy. The economic impact alone of BARI will be significant considering the large amount of health care dollars spent on coronary artery disease each year. BARI was designed to compare the benefits and risks of PTCA and CABG through random assignment of revascularization strategy and systematic follow-up over five or more years. Investigators randomized a total of 1829 patients (129 at Duke) and have followed these patients with telephone contact, clinical evaluations, exercise treadmill tests, lipid panels and in-depth socioeconomic surveys. In addition, 310 randomized patients at seven participating sites underwent coronary angiography at 10-14 months following the baseline angiogram.
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