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Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators.
Am Heart J. 2001 Jul; 142(1):119-26.AH

Abstract

BACKGROUND

Studies of survival of patients with multivessel coronary artery disease (MVD) in the prestent era suggested that outcomes after coronary artery bypass surgery (CABG) are similar to those after percutaneous coronary intervention (PCI) in subsets of coronary severity. The purpose of this study of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) was to examine the association between treatment and survival up to 5 years in patients with MVD enrolled from 1995 through 1998.

METHODS AND RESULTS

Data on patient characteristics were obtained at the time of the initial coronary angiography. Survival was determined through data linkage to the provincial Bureau of Vital Statistics. Risk-adjusted hazard ratios were calculated to compare different treatments. In the 11,661 patients with MVD, CABG was the initial therapy in 3782, PCI in 3540, and medical therapy in 4339. Cumulative 5-year survival was 91.4% with CABG, 91.9% with PCI, and 82.9% with medical therapy (P <.001). Hazard ratios were CABG: medical 0.53 (95% confidence interval [CI] 0.46-0.71), PCI: medical 0.65 (95% CI 0.56-0.74), and CABG: PCI 0.81 (95% CI 0.68-0.96). Analysis across coronary severity groups revealed a benefit of CABG compared with PCI only in the group with severe left main CAD: 0.30 (95% CI 0.17-0.54).

CONCLUSIONS

In a multicenter clinical setting, MVD patients treated with revascularization have significantly higher 5-year survival rate than do those treated medically. Risk-adjusted comparison reveals PCI treatment to be associated with long-term survival similar to treatment with CABG in all coronary severity subgroups except the group with severe left main coronary artery disease. Patient selection factors are likely to be contributing to these findings.

Authors+Show Affiliations

University of Alberta Hospital, and the Royal Alexandra Hospital, Edmonton, Alberta, Canada. vlad.dzavik@uhn.on.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

11431667

Citation

Dzavik, V, et al. "Long-term Survival in 11,661 Patients With Multivessel Coronary Artery Disease in the Era of Stenting: a Report From the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators." American Heart Journal, vol. 142, no. 1, 2001, pp. 119-26.
Dzavik V, Ghali WA, Norris C, et al. Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. Am Heart J. 2001;142(1):119-26.
Dzavik, V., Ghali, W. A., Norris, C., Mitchell, L. B., Koshal, A., Saunders, L. D., Galbraith, P. D., Hui, W., Faris, P., & Knudtson, M. L. (2001). Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. American Heart Journal, 142(1), 119-26.
Dzavik V, et al. Long-term Survival in 11,661 Patients With Multivessel Coronary Artery Disease in the Era of Stenting: a Report From the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. Am Heart J. 2001;142(1):119-26. PubMed PMID: 11431667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. AU - Dzavik,V, AU - Ghali,W A, AU - Norris,C, AU - Mitchell,L B, AU - Koshal,A, AU - Saunders,L D, AU - Galbraith,P D, AU - Hui,W, AU - Faris,P, AU - Knudtson,M L, AU - ,, PY - 2001/6/30/pubmed PY - 2001/8/10/medline PY - 2001/6/30/entrez SP - 119 EP - 26 JF - American heart journal JO - Am Heart J VL - 142 IS - 1 N2 - BACKGROUND: Studies of survival of patients with multivessel coronary artery disease (MVD) in the prestent era suggested that outcomes after coronary artery bypass surgery (CABG) are similar to those after percutaneous coronary intervention (PCI) in subsets of coronary severity. The purpose of this study of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) was to examine the association between treatment and survival up to 5 years in patients with MVD enrolled from 1995 through 1998. METHODS AND RESULTS: Data on patient characteristics were obtained at the time of the initial coronary angiography. Survival was determined through data linkage to the provincial Bureau of Vital Statistics. Risk-adjusted hazard ratios were calculated to compare different treatments. In the 11,661 patients with MVD, CABG was the initial therapy in 3782, PCI in 3540, and medical therapy in 4339. Cumulative 5-year survival was 91.4% with CABG, 91.9% with PCI, and 82.9% with medical therapy (P <.001). Hazard ratios were CABG: medical 0.53 (95% confidence interval [CI] 0.46-0.71), PCI: medical 0.65 (95% CI 0.56-0.74), and CABG: PCI 0.81 (95% CI 0.68-0.96). Analysis across coronary severity groups revealed a benefit of CABG compared with PCI only in the group with severe left main CAD: 0.30 (95% CI 0.17-0.54). CONCLUSIONS: In a multicenter clinical setting, MVD patients treated with revascularization have significantly higher 5-year survival rate than do those treated medically. Risk-adjusted comparison reveals PCI treatment to be associated with long-term survival similar to treatment with CABG in all coronary severity subgroups except the group with severe left main coronary artery disease. Patient selection factors are likely to be contributing to these findings. SN - 0002-8703 UR - https://www.unboundmedicine.com/medline/citation/11431667/Long_term_survival_in_11661_patients_with_multivessel_coronary_artery_disease_in_the_era_of_stenting:_a_report_from_the_Alberta_Provincial_Project_for_Outcome_Assessment_in_Coronary_Heart_Disease__APPROACH__Investigators_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(01)66057-5 DB - PRIME DP - Unbound Medicine ER -