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Angioplasty vs Bypass Surgery in Patients With Multivessel Coronary Artery Disease

Carmen E. Guerra, MD; Dilip B. Viswanath, MD
JAMA. 1997;278(2):114-115. doi:10.1001/jama.1997.03550020046025.
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To the Editor.  —The Bypass Angioplasty Revascularization Investigation (BARI) Investigators1 reported a greater need for additional revascularization procedures among patients who were initially randomized to percutaneous transluminal coronary angioplasty (PTCA[52%]), compared with those randomized to coronary artery bypass graft (CABG [6%]), to attain angina-free status at 5 years. However, since the time of randomization of patients in the BARI (which occurred between 1988 and 1991), clinical practice has changed to reflect key new information acquired from more recent clinical trials.Among the most important of these changes is the use of coronary stents, which has revolutionized interventional cardiology. In 1994, 2 randomized trials2,3 revealed that using stents reduced the restenosis rate by 30% compared with PTC A. Since these trials, we also have learned more about the appropriate indications for stent placement, including their use for abrupt vessel closure following PTCA4 to reduce the need for emergency


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