What is the difference in the five-year survival of patients in the BARI trial treated with CABG or PTCA?
Five year survival in the BARI trial for 1829 randomized patients was 89.3% for CABG and 86.3% for PTCA (p=.17). However, patients subseted by those with diabetes treated with either oral agents or insulin showed a 15% survival advantage of CABG over PTCA at five years in contrast to no survival difference between assessments for those patients without diabetes. Similar trends are apparent in the smaller CABRI trial and suggest that CABG should be considered the first line of treatment in this patient group. These results raise a question of whether PTCA might also be less effective than CABG in single-vessel patients who are diabetic. Further investigation is needed to define the mechanisms underlying the better observed outcome in diabetic patients treated with CABG in comparison to angioplasty.
