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European Heart Journal Advance Access published online on June 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi385
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received July 14, 2004
Revised April 30, 2005
Accepted June 2, 2005

Clinical research

13-year follow-up of the German angioplasty bypass surgery investigation

Jan Kaehler 1*, Ralf Koester 1, Wibke Billmann 1, Christian Schroeder 1, Hans-Jürgen Rupprecht 2, Thomas Ischinger 3, Roland Jahns 4, Albrecht Vogt 5, Martin Lampen 6, Rainer Hoffmann 7, Reimer Riessen 8, Joachim Berger 9, Thomas Meinertz 1, and Christian W. Hamm 10

1 Department of Cardiology, University Hospital Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
2 Department of Cardiology, Klinikum Rüsselsheim, Germany
3 Department of Cardiology, Klinikum Bogenhausen, Munich, Germany
4 Department of Cardiology, University Hospital Würzburg, Germany
5 Department of Cardiology, Burgfeld Hospital, Kassel, Germany
6 Department of Cardiology, German Heart Center Munich, Germany
7 Department of Cardiology, University Hospital Aachen, Germany
8 Department of Cardiology, University Hospital Tübingen, Germany
9 Institute for Medical Biometrics and Epidemiology, University Hospital Hamburg, Germany
10 Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany

* To whom correspondence should be addressed.
Jan Kaehler, E-mail: kaehler{at}uke.uni-hamburg.de


  Abstract

Aims The German Angioplasty Bypass Surgery Investigation was designed to compare symptomatic efficacy and safety of percutaneous coronary balloon angioplasty (PTCA) with coronary artery bypass surgery (CABG) in patients with symptomatic multi-vessel disease. This follow-up study was performed to determine the long-term outcome of patients following these interventions.

Methods and results From 1986 to 1991, 359 patients with angina CCS class II-IV, age below 75 years, and coronary multi-vessel disease requiring revascularization of at least two major coronary vessels were recruited at eight German centres and randomized to PTCA or CABG. From 337 patients undergoing the planned procedure, 324 patients could be followed-up (96%). Baseline parameters were identical in both groups, 2.2 ± 0.6 vessels were treated in CABG patients, whereas 1.9 ± 0.5 vessels were treated in PTCA patients. Thirty-seven per cent of surgical patients received internal mammary artery grafts, while no stents were used in patients undergoing PTCA. At the end of the 13-year follow-up period, the degree of angina, the degree of dyspnea, and the utilization of nitrates were comparable in both groups. With a total number of 76 deaths, Kaplan-Meier analysis revealed a comparable distribution in both groups. Although time to first re-intervention was significantly shorter in the PTCA group, P < 0.001, frequencies of re-intervention (CABG, n = 94; PTCA, n = 136) and crossover rates (CABG to PTCA, n = 49; PTCA to CABG, n = 51) were comparable in both groups.

Conclusion The results of our 13-year follow-up suggest that in patients with symptomatic multi-vessel disease, both PTCA and CABG are associated with a comparable long-term survival and symptomatic efficacy. How far these results may be altered by developments such as drug-eluting stents or off-pump surgery remains to be determined.

Keywords: Coronary artery disease; Percutaneous coronary balloon angioplasty; Coronary artery bypass surgery; Long-term follow-up; Survival; Symptomatic efficacy.
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