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July 9, 1997

Angioplasty vs Bypass Surgery in Patients With Multivessel Coronary Artery Disease-Reply

Author Affiliations

University of Pittsburgh Pittsburgh, Pa

JAMA. 1997;278(2):115. doi:10.1001/jama.1997.03550020047026

In Reply.  —Drs Guerra and Viswanath question the relevance to current practice of our findings from the BARI study of higher repeat revascularization rates in patients assigned to PTCA vs those assigned to CABG. It is possible, based on the findings from STRESS trials,1,2 that stent use could have reduced the need for repeat revascularization in diabetic patients in the BARI trial. However, even if stents had been available in the BARI, it seems highly unlikely based on the STRESS results that rates of repeat revascularization would have been similar for patients who received CABG or PTCA.In the STRESS trials, the reported rate of fi-month target lesion revascularization (repeat PTCA or CABG) among patients who received stents was 13%.2 This rate was only 2% in BARI patients assigned to CABG. Thus, despite a markedly worse baseline profile, including more extensive coronary disease, BARI patients who initially received CABG had