Coronary Artery Bypass Grafting (CABG): Reassessing Efficacy, Safety, and Cost

David K. Cundiff

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Risk Factor Data From the Bypass or Angioplasty Revascularization Intervention (BARI)

Beginning in 1987, the BARI investigators randomized 1829 CAD patients with multivessel disease to either CABG or angioplasty.[46,48,105,106,107,108,109] Unlike previous randomized comparisons of CABG and medical therapy or CABG and angioplasty, the BARI researchers kept coronary risk factor data at the baseline and subsequently at 4-14 weeks postintervention, at 1 year, at 3 years, and at 5 years.[48] An important aspect of both arms of the study was the regular reinforcement of coronary risk factor reduction recommendations by the primary care physicians.[48]

A highly significant difference between the 2 groups appeared at the 4- to 14-week visit when 53% of CABG patients reported regular exercise compared with 42% of PTCA patients (P < .001).[48] Overall, patients in both arms of the study dramatically increased participation in exercise programs from 16% at baseline to 42% at 5 years for both treatment groups.[48]

At baseline, approximately 25% of BARI patients were smokers,[48] considerably less than the 43% rate of smoking in the major studies comparing CABG with medical management.[7] At the 4- to 14-week follow-up, BARI patients reduced smoking to 8% in the CABG arm vs 12% of PTCA patients (P > .001). Smoking rates were no longer significantly different by 12 months (ie, 12% for CABG patients vs 14% for angioplasty patients), and at 5 years, 14% in both treatment groups reported smoking.[48]

Patients in both arms of the BARI trial reported radical dietary changes with major reductions in dietary fat.[48] However, the low-density lipoprotein (LDL) cholesterol levels at 4-14 weeks showed an average 4-point increase in the angioplasty patients and a 6-point decrease in the CABG patients (change in LDL cholesterol, P < .01).[48] This and other significant changes in serum lipid levels disappeared by 12 months.[48]

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