BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION

这项调查的目的是比较 经皮冠状动脉腔内成形术(PTCA)与冠状动脉搭桥术 手术(CABG)作为缓解心肌缺血的手段 有症状性多支冠状动脉病变的患者。特定的 目标包括：1)确定PTCA是否与CABG一样有效 缓解运动所致的心肌缺血；2)确定 死亡和心肌梗死等冠状动脉事件的发生率不同 在接受PTCA或CABG治疗的患者中；3)确定PTCA 结果与冠脉搭桥术相比，病理性事件的发生率更低；4)评估 经皮冠状动脉腔内成形术(PTCA)对心肌缺血的远期疗效 CABG和PTCA对就业的影响；6)评估经济成本 与每项干预相关联，无论是短期还是长期。 致残的慢性心绞痛、不稳定型心绞痛患者， 与心肌梗死相关的心绞痛 运动性脑缺血的心电图证据或患者 接受心脏手术的患者有轻微心绞痛和明显心肌缺血的证据 罗德岛医院的导尿术将被认为是有潜力的 随机化PTCA或冠状动脉搭桥术的候选对象。 有原发性心肌或瓣膜心脏的导尿术患者 患有疾病或没有冠状动脉疾病的证据，或不符合 将考虑功能标准来登记参加观察站 注册表。同意随机分组的患者将接受彻底的 基线评估，如果合适，包括分级运动测试，之前 至PTCA或CABG的性能。随机分组的患者将被 然后定期发放问卷，在12岁时进行分级运动压力测试 和48个月，作为协议的补充，心导管术在 12个月和60个月。病人进入登记处的临床结果 将通过问卷调查的方式进行评估。的主要终结点 调查将是患者证明证据的比例 在12个月和48个月时评估运动性缺血。多个辅助服务器 还将根据以下具体目标监测终点 这项调查。

The objective of this investigation is to compare the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) and coronary bypass surgery (CABG) as means of achieving relief of myocardial ischemia in patients with symptomatic multivessel coronary artery disease. Specific aims include: 1) to determine whether PTCA is as effective as CABG in relieving exercise induced myocardial ischemia; 2) to determine whether the incidence of coronary events such as death and myocardial infarction differ among patients treated with PTCA or CABG; 3) to determine whether PTCA results in a lower incidence of morbid events than CABG; 4) to assess the lasting effect of PTCA in relieving myocardial ischemia; 5) to assess the impact of CABG and PTCA on employment; 6) to assess the economic costs associated with each intervention, both short and long term. Patients with disabling chronic angina pectoris, unstable angina pectoris, angina pectoris following myocardial infarction associated with electrocardiographic evidence of exercise induced ischemia or patients with mild angina and evidence of marked myocardial ischemia who undergo cardiac catheterization at Rhode Island Hospital will be considered potential candidates for randomization to PTCA or coronary bypass surgery. Catheterized patients who do have primary myocardial or valvular heart disease or no evidence of coronary disease or who do not meet one of the functional criteria will be considered for enrollment in an observational Registry. Patients who consent to randomization will undergo a thorough baseline assessment including graded exercise tests if appropriate, prior to performance of either PTCA or CABG. Randomized patients will be followed with periodic questionnaires, graded exercise stress tests at 12 and 48 months and as supplement to the protocol, cardiac catheterization at 12 and 60 months. The clinical outcome of patients entering the Registry will be assessed by means of a questionnaire. The primary endpoint of this investigation will be the proportion of patients demonstrating evidence of exercise induced ischemia assessed at 12 and 48 months. Multiple secondary end points will also be monitored in accordance with the specific aims of the investigation.