Copyright © 1999 by the European Society of Cardiology.
Comparing outcomes of percutaneous transluminal coronary angioplasty with coronary artery bypass grafting. Can routine health service data complement and enhance randomized controlled trials?
a Public Health Research Unit, University of Glasgow, Glasgow
b Medical Statistics Unit, University of Edinburgh Medical School, Edinburgh, Scotland, U.K.
revised May 11, 1999; accepted May 12, 1999
Abstract
Aim To compare outcomes of percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass graft surgery (CABG) for a population stemming from routinely collected data, in order to assess the merits of such data sources as a complement, and possible enhancement, to randomized controlled trial results.
Methods and Results A population of Scottish patients were taken from a routine discharge summary and from this data source patients comparable to those from randomized controlled trial settings were identified. Between 1989 and 1995, 12238 pseudo randomized controlled trial patients were identified from the routine data set, of which 3714 (30·3%) received PTCA and 8524 (69·7%) received CABG. The baseline characteristics of the pseudo randomized controlled trial and randomized controlled trial patients were similar. The evidence from both the randomized controlled trials and routine data indicate that for 1 year follow-up the risk of cardiac death and/or non-fatal myocardial infarction is not significantly different between the two treatment groups.
Conclusion The outcomes expected of PTCA and CABG following trial evidence have been realized in the routine data which are representative of a complete, non-selective population. Due to the size of the routine data set it would be possible to set up hypotheses for potential subgroup effects at the outset.
Key Words: Coronary revascularization, routine data, randomized controlled trials, meta-analysis, subgroup analysis
f1 Correspondence: J. D. Lewsey, National Centre for Transcultural Oral Health, Eastman Dental Institute for Oral Health Care Sciences, University of London, 256 Gray's Inn Road, London WC1X 8LD, U.K.
References
- Henderson, RA, Coronary Angioplasty and Coronary Artery Bypass Surgery, Pitt, B, Julian, D, Pocock, SJ, Clinical Trials in Cardiology, London, W.B. Saunders Company Ltd, 1997, 203, 20
- N Engl J Med. 1996;335:217–225
[Abstract/Free Full Text] - Lancet. 1995;346:1179–1183[CrossRef][Web of Science][Medline]
- Henderson RA. (RITA) Trial protocol: a long term study of coronary angioplasty and coronary artery bypass surgery in patients with angina. Br Heart J. 1989;62:411–414
[Abstract/Free Full Text] - Lancet. 1993;341:573–580[CrossRef][Web of Science][Medline]
- King SB III, Lembo NJ, Weintraub WS. A randomised trial comparing coronary angioplasty with coronary bypass surgery. N Engl J Med. 1994;331:1044–1050
[Abstract/Free Full Text] - Hamm CW, Reimers J, Ischinger T. A randomised study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. N Engl J Med. 1994;331:1037–1043
[Abstract/Free Full Text] - Puel J, Karouny E, Marco F. Angioplasty versus surgery in multivessel disease: immediate results and in-hospital outcome in a randomised prospective study. Circulation. 1992;86:I-372
- Hueb WA, Bellotti G, Almeida de Oliveira S. The Medicine, Angioplasty or Surgery Study (MASS): a prospective, randomised trial of medical therapy, balloon angioplasty or bypass surgery for single proximal left anterior descending artery stenoses. J Am Coll Cardiol. 1995;26:1600–1605[Abstract]
- Goy J-J, Eeckhout E, Burnand B. Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis. Lancet. 1994;343:1449–1453[CrossRef][Web of Science][Medline]
- Rodriguez A, Boullon F, Perez-Balino N. Argentine Randomised Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI): in-hospital results and 1-year follow-up. J Am Coll Cardiol. 1993;22:1060–1067[Abstract]
- Pocock SJ, Henderson RA, Rickards AF. Meta-analysis of randomised trials comparing coronary angioplasty with bypass surgery. Lancet. 1995;346:1184–1189[CrossRef][Web of Science][Medline]
- Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ. 1996;312:1215–1218
[Free Full Text] - Kendrick S, Clarke J. The Scottish record linkage system. Health Bulletin. 1993;51:72–79[Medline]
- Manual of the international statistical classification of diseases, injuries, and causes of death. Ninth revision. Geneva: WHO; 1977.
- Classification of surgical operations and procedures. Fourth revision. London: OPCS; 1987.
- Smith, TC, Abrams, KR, Jones, DR, Hierarchical models in generalised synthesis of evidence: an example based on studies of breast cancer screening. Technical Report (Statistics) 95-02 (1995), Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
- White HD. Angioplasty versus bypass surgery. Lancet. 1995;346:1174–1175[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Garcia, K. Julier, L. Bestmann, A. Zollinger, L. K. von Segesser, T. Pasch, D. R. Spahn, and M. Zaugg Preconditioning with sevoflurane decreases PECAM-1 expression and improves one-year cardiovascular outcome in coronary artery bypass graft surgery Br. J. Anaesth., February 1, 2005; 94(2): 159 - 165. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.T. van Domburg, J.J.M. Takkenberg, L.A. van Herwerden, A.C. Venema, and A.J.J.C. Bogers Short-term and 5-year outcome after primary isolated coronary artery bypass graft surgery: results of risk stratification in a bilocation center Eur. J. Cardiothorac. Surg., April 1, 2002; 21(4): 733 - 740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.Z. Ayanian Using administrative data to assess health care outcomes Eur. Heart J., December 1, 1999; 20(23): 1689 - 1691. [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||