Eight-year mortality in the Emory Angioplasty versus Surgery Trial (EAST)

• Published in: Journal of the American College of Cardiology Vol. 35; no. 5; pp. 1116 - 1121
• Main Authors: King, Spencer B, Kosinski, Andrzej S, Guyton, Robert A, Lembo, Nicholas J, Weintraub, William S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2000; Elsevier Science
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary Artery Bypass; Coronary Disease - complications; Coronary Disease - diagnostic imaging; Coronary Disease - mortality; Coronary Disease - therapy; Coronary heart disease; Diabetes Complications; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - etiology; Proportional Hazards Models; Stroke Volume; Surveys and Questionnaires; Survival Analysis; Treatment Outcome; BARI; NHLBI; MI; EAST; CAD; PTCA; Human; Prognosis; Coronary artery; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Survival; Treatment; Aortocoronary; Bypass; Follow up study; Surgery; Comparative study
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(00)00546-5

OBJECTIVES
To evaluate the long-term outcome of patients randomized to coronary bypass surgery or coronary angioplasty.
BACKGROUND
The Emory Angioplasty versus Surgery Trial (EAST) is a single center randomized comparison of a strategy of initial coronary angioplasty (n = 198) or coronary bypass surgery (n = 194) for patients with multivessel coronary artery disease. The primary end point (death, myocardial infarction or a large ischemic defect at 3 years) was not different, and repeat revascularization was significantly greater in the angioplasty group. Subsequently, the National Heart, Lung and Blood Institute supported a five-year extension of the trial.
METHODS
After the three year anniversary visit, annual questionnaires, telephone contact and examination of medical records were accomplished until death or the eight year anniversary in 100% of the patients surviving at 3 years.
RESULTS
Survival at 8 years is 79.3% in the angioplasty group and 82.7% in the surgical group (p = 0.40). Patients with proximal left anterior descending stenosis and those with diabetes tended to have better late survival with surgical intervention although not reaching statistical significance. After the first 3 years, repeat interventions remained relatively equal for both treatment groups.
CONCLUSIONS
Long-term survival is not significantly different between angioplasty and surgery, and late (three to eight year) revascularization procedures were infrequent. Patients without treated diabetes had similar survival in both groups.