Predictors of Mortality and Mortality From Cardiac Causes in the Bypass Angioplasty Revascularization Investigation (BARI) Randomized Trial and Registry

Author:

Brooks Maria Mori1,Jones Robert H.1,Bach Richard G.1,Chaitman Bernard R.1,Kern Morton J.1,Orszulak Thomas A.1,Follmann Dean1,Sopko George1,Blackstone Eugene H.1,Califf Robert M.1

Affiliation:

1. From the University of Pittsburgh, Pittsburgh, Pa (M.M.B.); Duke University Medical Center, Durham, NC (R.H.J., R.M.C.); St Louis University Health Sciences Center, St Louis, Mo (R.G.B., B.R.C., M.J.K.); the Mayo Clinic, Rochester, Minn (T.A.O.); the National Heart, Lung, and Blood Institute, Bethesda, Md (D.F., G.S.); and the Cleveland Clinic, Cleveland, Ohio (E.H.B.).

Abstract

Background —The impact of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) on long-term mortality rates in the presence of various demographic, clinical, and angiographic factors is uncertain in the population of patients suitable for both procedures. Methods and Results —In the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial and registry, 3610 patients who were eligible to receive PTCA and CABG were revascularized between 1989 and 1992. Multivariate Cox models were used to identify factors associated with 5-year mortality and cardiac mortality, with particular attention to factors that interact with treatment. Diabetic patients receiving insulin had higher mortality and cardiac mortality rates with PTCA compared with CABG (relative risk [RR] 1.78 and 2.63, respectively, P <0.001), and patients with ST elevation had higher cardiac mortality rates with CABG than with PTCA (RR 4.08, P <0.001). Factors most strongly associated with high overall mortality rates were insulin-treated diabetes, congestive heart failure, kidney failure, and older age. Black race was also associated with higher mortality rates (RR 1.49, P =0.019). Conclusions —A set of variables was identified that could be used to help select a revascularization procedure and to evaluate risk of long-term mortality in the population of patients considering revascularization.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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