Ten-Year Follow-Up Survival of The Medicine, Angioplasty, or Surgery Study (MASS-II): A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies For Multivessel Coronary Artery Disease

Heart Institute of the University of São Paulo, São Paulo, Brazil.
Circulation (Impact Factor: 14.43). 09/2010; 122(10):949-57. DOI: 10.1161/CIRCULATIONAHA.109.911669
Source: PubMed


This study compared the 10-year follow-up of percutaneous coronary intervention (PCI), coronary artery surgery (CABG), and medical treatment (MT) in patients with multivessel coronary artery disease, stable angina, and preserved ventricular function.
The primary end points were overall mortality, Q-wave myocardial infarction, or refractory angina that required revascularization. All data were analyzed according to the intention-to-treat principle. At a single institution, 611 patients were randomly assigned to CABG (n=203), PCI (n=205), or MT (n=203). The 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69% with MT (P=0.089). The 10-year rates of myocardial infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT (P<0.010). The 10-year rates of additional revascularizations were 7.4% with CABG, 41.9% with PCI, and 39.4% with MT (P<0.001). Relative to the composite end point, Cox regression analysis showed a higher incidence of primary events in MT than in CABG (hazard ratio 2.35, 95% confidence interval 1.78 to 3.11) and in PCI than in CABG (hazard ratio 1.85, 95% confidence interval 1.39 to 2.47). Furthermore, 10-year rates of freedom from angina were 64% with CABG, 59% with PCI, and 43% with MT (P<0.001).
Compared with CABG, MT was associated with a significantly higher incidence of subsequent myocardial infarction, a higher rate of additional revascularization, a higher incidence of cardiac death, and consequently a 2.29-fold increased risk of combined events. PCI was associated with an increased need for further revascularization, a higher incidence of myocardial infarction, and a 1.46-fold increased risk of combined events compared with CABG. Additionally, CABG was better than MT at eliminating anginal symptoms. Clinical Trial Registration Information- URL: Registration number: ISRCTN66068876.

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    • "CABG or PCI Medical therapy Composite: mortality, MI, revasc. (10 years); individual end points Hueb et al 2010 39 MASSIII Circ 2010 308 Off-pump CABG On-pump CABG Composite: mortality, MI, CVA, revasc. (5 years) Kapur et al 2010 40 CARDia JACC 2010 510 PCI CABG Composite: mortality, MI, CVA (1 year) Moller et al 2010 41 Best Bypass Surgery Circ 2010 341 Off-pump CABG On-pump CABG Composite: mortality, MI, CVA, cardiac arrest, low CO syndrome, revasc. "
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    ABSTRACT: Background: There is currently no accepted standard for reporting outcomes following cardiac surgery. The objective of this paper was to systematically review the literature to evaluate the current use and definition of perioperative outcomes reported in cardiac surgery trials. Methods and results: We reviewed 5 prominent medical and surgical journals on Medline from January 1, 2010, to June 30, 2014, for randomized controlled trials involving coronary artery bypass grafting and/or valve surgery. We identified 34 trials meeting inclusion criteria. Sample sizes ranged from 57 to 4752 participants (median 351). Composite end points were used as a primary outcome in 56% (n=19) of the randomized controlled trials and as a secondary outcome in 12% (n=4). There were 14 different composite end points. Mortality at any time (all-cause and/or cardiovascular) was reported as an individual end point or as part of a combined end point in 82% (n=28), myocardial infarction was reported in 68% (n=23), and bleeding was reported in 24% (n=8). Patient-centered outcomes, such as quality of life and functional classification, were reported in 29% (n=10). Definition of clinical events such as myocardial infarction, stroke, renal failure, and bleeding varied considerably among trials, particularly for postoperative myocardial infarction and bleeding, for which 8 different definitions were used for each. Conclusions: Outcome reporting in the cardiac surgery literature is heterogeneous, and efforts should be made to standardize the outcomes reported and the definitions used to ascertain them. The development of standardizing outcome reporting is an essential step toward strengthening the process of evidence-based care in cardiac surgery.
    Journal of the American Heart Association 08/2015; 4(8). DOI:10.1161/JAHA.115.002204 · 4.31 Impact Factor
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    • "The presence or absence of the necessity for making any change in lifestyle is an improvement factor in quality of life after sustaining PTCA (Pasquali Alexander, Coombs, Lytli, & Peterson, 2003).QOL is not related to the time after procedure but it is associated with some other factors such as gender (lower level of QOL in women after PTCA), age, unstable angina, diabetes mellitus, and multi veins involvement and Thrombosis formulation (Fortescue Kahn, & Bates, 2003). Patients with PTCA Complain of the high level of weakness and restriction in there and more anxious compared to those who experienced CABG (Hueb et al., 2010). The sexual satisfaction of the patients improves until 8 years after PTCA. "
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    ABSTRACT: Coronary artery diseases are the main causes of death in industrial Countries. Transluminal angioplasty is a common technique used to manage the condition of coronary arteries. The purpose of this study was to explore the quality of life in patients sustaining this measure in two stages before the procedure and then three consecutive after that 3, 6 and 12 months respectively. This research was a longitudinal study and data was collected between 2011-2013 years. 115 patients were included. Data were collected through using a questionnaire with 40 questions. The subjects before, 3, 6 and 12months after the procedure filled out questioner. Data were analyzed by statistical tests including T- test, Fisher exact test, Wilcoxon and Friedman with Software SPSS version 16, P value<0.05. There were significant differences in the quality of life in patients with PTCA before procedure and 3 months after that (P=0.004). Quality of life of patients undergoing PTCA in the four levels, three, six and twelve months after the operation had a significant difference (P <0.001). Quality of life of people with PTCA operation three months after surgery is reduced. It is required during this period the patient treatment team and supports his family and put under the necessary training in this period to give patients and encourage them to pursue their condition should.
    Global journal of health science 02/2015; 7(5). DOI:10.5539/gjhs.v7n5p246
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    • "The MASS II study design has been previously described [8]. We performed a post hoc analysis specifically of 188 (30.8%) women in the prospective MASS II study with 10 years of follow-up (mean ± standard deviation: 6.8 ± 3.7 years), which randomized a total of 611 patients with multivessel chronic stable CAD to optimal MT, PCI, or CABG after the agreement, respectively, of the clinician, the interventionist and the cardiac surgeon. "
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    ABSTRACT: OBJECTIVES Coronary artery disease is the leading cause of death in women. The proposed treatments for women are similar to those for men. However, in women with multivessel stable coronary artery disease and normal left ventricular function, the best treatment is unknown.
    Interactive Cardiovascular and Thoracic Surgery 09/2014; 19(6). DOI:10.1093/icvts/ivu288 · 1.16 Impact Factor
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