Coronary stenting versus coronary bypass surgery in patients with multiple vessel disease and significant proximal LAD stenosis: results from the ERACI II study.

PURPOSE: To compare percutaneous coronary intervention (PCI) using stent implantation versus coronary artery bypass graft (CABG) in patients with multiple vessel disease with involvement of the proximal left anterior descending coronary artery (LAD). METHODS: 230 patients with multiple vessel disease and severe stenosis of the proximal LAD (113 with PCI, 117 with CABG). They were a cohort of patients from the randomised ERACI (Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease) II study. RESULTS: Both groups had similar baseline characteristics. There were no significant differences in 30 day major adverse cardiac events (death, myocardial infarction, stroke, and repeat procedures) between the strategies (PCI 2.7% v CABG 7.6%, p = 0.18). There were no significant differences in survival (PCI 96.4% v CABG 95%, p = 0.98) and survival with freedom from myocardial infarction (PCI 92% v CABG 89%, p = 0.94) at 41.5 (6) months' follow up. However, freedom from new revascularisation procedures (CABG 96.6% v PCI 73%, p = 0.0002) and frequency of angina (CABG 9.4% v PCI 22%, p = 0.025) were superior in the CABG group. CONCLUSION: Patients with multivessel disease and significant disease of the proximal LAD randomly assigned in the ERACI II trial to PCI or CABG had similar survival and survival with freedom from myocardial infarction at long term follow up. Repeat revascularisation procedures were higher in the PCI group.

Argentine Randomized Study: Coronary Angioplasty with Stenting versus Coronary Bypass Surgery in patients with Multiple-Vessel Disease (ERACI II): 30-day and one-year follow-up results. ERACI II Investigators.

OBJECTIVE: The purpose of this study was to compare percutaneous transluminal coronary revascularization (PTCR) employing stent implantation to conventional coronary artery bypass graft surgery (CABG) in symptomatic patients with multivessel coronary artery disease. BACKGROUND: Previous randomized studies comparing balloon angioplasty versus CABG have demonstrated equivalent safety results. However, CABG was associated with significantly fewer repeat revascularization procedures. METHODS: A total of 2,759 patients with coronary artery disease were screened at seven clinical sites, and 450 patients were randomly assigned to undergo either PTCR (225 patients) or CABG (225 patients). Only patients with multivessel disease and indication for revascularization were enrolled. RESULTS: Both groups had similar clinical demographics: unstable angina in 92%; 38% were older than 65 years, and 23% had a history of peripheral vascular disease. During the first 30 days, PTCR patients had lower major adverse events (death, myocardial infarction, repeat revascularization procedures and stroke) compared with CABG patients (3.6% vs. 12.3%, p = 0.002). Death occurred in 0.9% of PTCR patients versus 5.7% in CABG patients, p < 0.013, and Q myocardial infarction (MI) occurred in 0.9% PTCR versus 5.7% of CABG patients, p < 0.013. At follow-up (mean 18.5 +/- 6.4 months), survival was 96.9% in PTCR versus 92.5% in CABG, p < 0.017. Freedom from MI was also better in PTCR compared to CABG patients (97.7% vs. 93.4%, p < 0.017). Requirements for new revascularization procedures were higher in PTCR than in CABG patients (16.8% vs. 4.8%, p < 0.002). CONCLUSIONS: In this selected high-risk group of patients with multivessel disease, PTCR with stent implantation showed better survival and freedom from MI than did conventional surgery. Repeat revascularization procedures were higher in the PTCR group.

Long-term efficacy of amlodipine in patients with severe coronary artery disease.

The long-term efficacy of amlodipine was assessed in 21 patients with chronic stable angina. After a 2-week run-in period, patients received 5 mg amlodipine once daily for 2 weeks. This was increased to 10 mg daily during the following 10-week dose-adjustment/maintenance phase, if angina attacks were not abolished. Patients were then followed up for an additional 21 months (total 24 months). During follow-up, patients were evaluated at least once a month, and sitting blood pressure and heart rate were monitored. Angina attack rate and nitroglycerin consumption were recorded in angina diaries throughout the study. Patients underwent a treadmill exercise test at baseline, at the end of the dose-adjustment phase and again during long-term follow-up at 20 months. Amlodipine (mean final daily dose, 8.2 mg) resulted in a significant reduction in angina attack rate and nitroglycerin consumption (both p < 0.001), which was maintained during follow-up. Systolic blood pressure was also reduced (p < 0.01) by amlodipine. Diastolic blood pressure and heart rate were not significantly affected. Amlodipine significantly increased mean exercise time (p < 0.001). ST-segment depression at maximum common load was reduced when compared with baseline values (p < 0.001), and the metabolic equivalent (MET) score at peak exercise was significantly improved by amlodipine (p < 0.001). All of these effects on exercise performance were sustained during follow-up. These data indicate that long-term treatment with amlodipine, in patients with severe coronary artery disease, reduced the number of angina attacks and nitroglycerin consumption and produced a sustained improvement in exercise performance.

Anti-ischaemic properties of amlodipine, a new calcium antagonist, in patients with severe coronary artery disease: a prospective trial.

Amlodipine significantly reduced both weekly anginal attack rate and consumption of glyceryl trinitrate tablets in patients with severe coronary artery disease. Exercise tolerance also significantly improved, with a 79% increase in the exercise time to onset of angina and a 59% decrease in ST-segment depression. Blood pressure was decreased, with no significant change in heart rate. No serious adverse events occurred in any patient during amlodipine treatment.