NEW YORK (Reuters Health) – The 10-year outcomes data from the MASS II trial comparing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) and medical treatment for multivessel coronary artery disease indicate that CABG has advantages over the other two approaches, according to a findings published in the September 7 issue of Circulation, online August 23.
An editorial, however, suggests that PCI has improved in the intervening years to the point that it may rival CABG.
Dr. Whady Hueb with the Heart Institute of the University of Sao Paulo, Brazil, along with colleagues there and at the Mayo Clinic in Rochester, Minnesota report that among 611 patients randomly assigned to one of the three approaches, 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69.0% with medical treatment (p=0.089).
During the 10 years, MI occurred in 10.3%, 13.3%, and 20.7% of the three groups, respectively (p=0.010), while “the 10-year rates of additional revascularizations were 7.4% with CABG, 41.9% with PCI, and 39.4% with medical treatment (p=0.001),” the investigators found.
Furthermore, as a secondary outcome, freedom from angina at 10 years was documented in 64%, 59% and 43% of the three groups, respectively.
“In summary,” the authors write, “the MASS II trial strongly showed the benefits of PCI and CABG over medical treatment in regard to several primary end points at 10-year follow-up, although with similar rates of overall mortality. Additionally, CABG surgery was an independent predictor of higher rates of event-free survival.”
In an editorial, Dr. David O. Williams at Brigham and Woman’s Hospital, Boston, Massachusetts, and two colleagues point to the relatively small size of the study.
They also note that “cardiovascular therapies evolve and become more refined over time”, and that “arguably” PCI has evolved more than CABG and medical treatment. “Clinicians might be justified in anticipating that current-day PCI may provide results more similar to those achieved from CABG in MASS-II.”
Reference:
Ten-Year Follow-Up Survival of the Medicine, Angioplasty, or Surgery Study (MASS II). A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease
Circulation 2010;122:949-957.
