BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION (BARI

冠状动脉搭桥手术已被证明可以缓解心绞痛和 改善多支冠状动脉病变患者的生活质量 疾病。经皮冠状动脉腔内成形术(PTCA)是一种新的冠状动脉成形术 非手术血管重建技术正越来越多地被用于 多支冠状动脉病变的治疗。而当 经皮冠状动脉腔内成形术治疗单支病变的疗效观察 一般认为，多支血管的患者并非如此。 疾病。因此，这项试验的主要目的将是测试 认为经皮冠状动脉腔内成形术与冠状动脉旁路移植术同样有效的假说 有多支血管病变和严重症状，如 心绞痛缓解而不增加死亡风险或非致命性心肌梗塞超过5 好几年了。 一组随机的患者将从登记处派生，并将 符合入职标准的包括：年龄小于76岁，稳定 心绞痛CHC III-IV或不稳定型心绞痛合并多支冠状动脉病变 经冠状动脉搭桥术或经皮冠状动脉腔内成形术均可充分治疗。患者应该没有 先前的血管重建术，没有明显的非冠状动脉或 非心脏病。 同意随机分组的患者将每隔6个月接受一次随访 已经5年了。在有运动能力的患者中，进行铊运动试验 将在之前和之后的1个月以及1年、3年和5年获得 血运重建。重复的心导管检查将在 所有患者均为5年。心绞痛缓解情况由详细的 将调查问卷、医生访谈和心绞痛记录进行比较 在小组之间。死亡率和发病率将受到密切监测。 如果PTCA在缓解心绞痛方面与CABG一样有效，而不需要 任何死亡或非致命性心肌梗死风险的增加，这一发现都将对 对冠心病患者管理的影响。

Coronary artery bypass surgery has been demonstrated to relieve angina and improve the quality of life in patients with multivessel coronary artery disease. Percutaneous transluminal coronary angioplasty (PTCA) is a new nonsurgical revascularization technique that is increasingly being used for the treatment of patients with multivessel coronary disease. While efficacy of PTCA in the treatment of patients with single vessel disease is generally accepted, this is not the case for patients with multivessel disease. Therefore, the primary aim of this trial will be to test the hypothesis that PTCA is as effective as CABG in the treatment of patients with multivessel disease and severe symptoms as shown by an equivalent relief of angina without increased risk of death or nonfatal MI over 5 years. A randomizable group of patients will be derived from a registry and will satisfy entry criteria to include: Less than 76 years of age, stable angina CHC III-IV or unstable angina with multivessel CAD felt to be adequately treatable by either CABG or PTCA. The patients should have no prior revascularization procedure and no significant noncoronary or noncardiac disease. Patients consenting to randomization will be followed at 6 month intervals for 5 years. In patients capable of exercise, a thallium exercise test will be obtained before, and at 1 month and 1, 3, and 5 years after revascularization. A repeat cardiac catheterization will be obtained on all patients at 5 years. Angina relief assessed by a detailed questionnaire, physician interview, and anginal log will be compared between groups. Mortality and morbidity will be closely monitored. If PTCA is shown to be as effective as CABG in the relief of angina without any increased risk of death or nonfatal MI, this finding would have a major impact on the management of patients with coronary artery disease.