Bypass has been compared to angioplasty in trials. Study of the Bypass Angioplasty Revascularization Investigation (BARI) trial reported an increased death rate for diabetics in the angioplasty group compared to diabetics in the bypass group. Revascularization rates are higher in patients receiving angioplasty. This is the 8-year follow-up data from the Emory Angioplasty versus Surgery Trial (EAST), which randomized patients with multivessel CAD to either angioplasty (PTCA) or bypass (CABG).
	Between 1987 and 1990, 5118 patients with multivessel CAD were
screened. 842 patients had coronary anatomy eligible for either PTCA or CABG. Of these, 392 people were enrolled to have PTCA or CABG.
	The average age of the EAST patients was 61 years. 73% were men. 60% had 2-vessel CAD, and 40% had 3-vessel CAD. The average EF was 60% and
41% had a history of heart attack. 91% had Class 2 or 3 angina, and 23% were
diabetic.
	After 3 years of follow-up, there was no difference in overall mortality groups. There was a significant increase in repeat revascularization for PTCA patients. 59% in the PTCA group did not need a second PTCA, while 87% of the CABG group did not need further revascularization with PTCA. 78% of the PTCA group did not have later bypass surgery, while 99% of the CABG group did not have repeat CABG.
	Follow-up to death or 8 years is complete in 100% of patients. There was no significant difference in overall survival between patients in the 2 groups. When separating patients into 2-vessel or 3-vessel CAD, there was still no significant mortality difference. For those patients with proximal left anterior descending (LAD) disease, there was a trend toward improved survival with bypass (86%) versus angioplasty (80%). There was a small trend toward improved survival in diabetic patients having bypass (76%) versus angioplasty (60%). This mortality difference in diabetics did not reach statistical significance.
	8 year data also show that patients in the PTCA group had higher rates of later revascularization compared to those having bypass surgery. Repeat PTCA was done in 51% of the PTCA group, but in only 25% of the bypass group. Repeat bypass was done in 29% of PTCA patients, but in only 2% of bypass patients. The total number of repeat procedures was significantly higher in the angioplasty group (168 repeat PTCAs and 62 bypasses) compared to the bypass group (66 subsequent PTCAs and only 5 bypasses). Despite the higher rate of repeat revascularization in the angioplasty group, 97% of the PTCA group and 95% of the CABG group remained angina-free after 8 years.
	CONCLUSION: There is no difference in overall or cardiac survival when comparing patients with multivessel CAD who had PTCA versus CABG. There is a non-statistically significant trend toward improved survival with bypass in
patients who are diabetic and in those with proximal LAD disease.
Revascularization was significantly higher in patients having angioplasty. Both groups had excellent long-term angina control.

Title: Eight-Year Outcome in the Emory Angioplasty vs. Surgery Trial
Speaker: Spencer B. King III, MD, Emory University, Atlanta, Ga.