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

David K. Cundiff

In This Article

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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