First-year results of CABRI (Coronary Angioplasty versus Bypass Revascularisation Investigation). CABRI Trial Participants

Abstract

The Coronary Angioplasty versus Bypass Revascularisation Investigation (CABRI) is a multinational, multicentre randomised trial comparing the strategies of revascularisation by CABG (coronary artery bypass grafting) and PTCA (percutaneous transluminal coronary angioplasty) in patients with symptomatic multivessel coronary disease. 1054 patients (820 men and 234 women) were recruited from 26 European cardiac centres. The average age was 60 years and 62% presented with angina of class 3 or greater. 513 patients were randomised to CABG and 541 to PTCA, and 93% and 96%, respectively, of those randomised underwent the allocated procedure. This first report presents data analysed by intention to treat and documents all deaths, major cardiac events, and the symptom status of the patients 1 year after randomisation. After 1 year of follow-up, 14 (2.7%) of those randomised to CABG and 21 (3.9%) of those randomised to PTCA had died. The PTCA group's relative risk (RR) of death was 1.42 (95% CI 0.73-2.76). Patients randomised to PTCA required significantly more reinterventions; only 66.4% reached 1 year with a single revascularisation procedure compared with 93.5% of patients randomised to CABG (RR = 5.23 [3.90-7.03], p < 0.001). The patients in the PTCA group took significantly more medication at 1 year (RR = 1.30 [1.18-1.43], p < 0.001). They were also more likely to have clinically significant angina (RR = 1.54 [1.09-2.16], p = 0.012); this association was present in both sexes but was significant only in females. CABRI is the largest trial of CABG versus PTCA to be reported so far. Its findings are consistent with previous studies, and add to the weight of information that clinicians need to discuss with patients when options for the management of severe angina are under consideration.