Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS II)

Abstract

Background-Despite routine use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), no conclusive evidence exists that either modality is superior to medical therapy (MT) alone for treating multivessel coronary artery disease with stable angina and preserved ventricular function. Methods and Results-The primary end points were total mortality, Q-wave myocardial infarction, or refractory angina requiring revascularization. The study comprised 611 patients randomly assigned to undergo CABG (nϭ203), PCI (nϭ205), or MT (nϭ203). At the 5-year follow-up, the primary end points occurred in 21.2% of patients who underwent CABG compared with 32.7% treated with PCI and 36% receiving MT alone (Pϭ0.0026). No statistical differences were observed in overall mortality among the 3 groups. In addition, 9.4% of MT and 11.2% of PCI patients underwent repeat revascularization procedures compared with 3.9% of CABG patients (Pϭ0.021). Moreover, 15.3%, 11.2%, and 8.3% of patients experienced nonfatal myocardial infarction in the MT, PCI, and CABG groups, respectively (PϽ0.001). The pairwise treatment comparisons of the primary end points showed no difference between PCI and MT (relative risk, 0.93; 95% confidence interval, 0.67 to 1.30) and a significant protective effect of CABG compared with MT (relative risk, 0.53; 95% confidence interval, 0.36 to 0.77). Conclusions-All 3 treatment regimens yielded comparable, relatively low rates of death. MT was associated with an incidence of long-term events and rate of additional revascularization similar to those for PCI. CABG was superior to MT in terms of the primary end points, reaching a significant 44% reduction in primary end points at the 5-year follow-up of patients with stable multivessel coronary artery disease.

Long‐term Outcome of Patients Treated With Prophylactic Nesiritide for the Prevention of Acute Kidney Injury Following Cardiovascular Surgery

“…These findings likely represent the reported 30-day and 1-, 3-, and 5-year mortality rates of 7.1%, 15%, 22.1%, 18 and 30%, respectively, for thoracic aortic aneurysm surgery, 19 and the reported 4-6%, 20 5-8% 21 15%, 22 and 20% mortality rates for cardiac valve surgery. 23,24 The long-term mortality rate in this study (∼20%) is in accord with published data in patients undergoing CV surgery 18 -26 and may be linked to the associated excess comorbidities, toxicities, and adverse pathobiological states that accelerate cardiovascular damage. 27 Consistent with data from other studies, 8,13,14 patients with AKI following cardiac surgery had reduced long-term cumulative survival compared to those with no AKI, and this was irrespective of nesiritide status.…”

Miniesternotomia na cirurgia de revascularização miocárdica preserva função pulmonar pós-operatória

“…The CABG surgery presents low morbidity and mortality and has safe and reliable late outcomes 9,10 . However, the surgical aggression caused by the sternotomy and by on-pump surgeries results in longer hospital stay duration, mainly due to the PO pulmonary dysfunction 11 .…”

Guidelines on myocardial revascularization

“…• analysis was conducted on an intention-to-treat basis (even though 40% of the medical group crossed over to CABG); • only 10% of CABG patients received an internal thoracic artery (ITA); however the most important prognostic component of CABG is the use of one [47,48] [53]. Most patients in these RCTs actually had normal LV function with single or double vessel CAD and without proximal LAD disease.…”

“…Meta-analyses of these RCTs reported that CABG resulted in up to a five-fold reduction in the need for reintervention, with either no or a modest survival benefit or a survival benefit only in patients >65 years old (HR 0.82) and those with diabetes (HR 0.7) [29]. The 5-year follow-up of the MASS II [53] study of 611 patients (underpowered) reported that the composite primary endpoint (total mortality, Q-wave MI, or refractory angina requiring revascularization) occurred in 36% of OMT, 33% of PCI and 21% of CABG patients (P = 0.003), with respective subsequent revascularization rates of 9%, 11% and 4% (P = 0.02).…”