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
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: http://www.controlled-trials.com. Registration number: ISRCTN66068876.
[Show abstract] [Hide abstract] 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.0Comments 0Citations
- "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. "
[Show abstract] [Hide abstract] 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.0Comments 0Citations
- "The MASS II study design has been previously described . 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. "
[Show abstract] [Hide abstract] ABSTRACT: Objective To evaluate the relationships of lipoprotein(a) (Lp(a)) concentration and apolipoprotein(a) (apo(a)) phenotype to major adverse cardiovascular events after coronary artery bypass grafting (CABG) in long-term follow-up. Methods This single-center study included 356 patients with stable coronary heart disease (CHD) who underwent successful CABG. At baseline, we assessed the patient’s risk factor profile for atherosclerosis, Lp(a) concentration and apo(a) phenotype. The primary endpoint was the composite of cardiovascular death and non-fatal myocardial infarction (MI). The secondary endpoint also included hospitalization for recurrent or unstable angina and repeat revascularization. Results Over a mean of 8.5±3.5 years (range 0.9-15.0 years), the primary and secondary endpoints were registered in 46 (13%) and 107 (30%) patients, respectively. Patients with Lp(a) ≥30 mg/dL were at significantly greater risk for the primary endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76-5.03, p<0.001) and secondary endpoint (HR 3.47, 95% CI 2.48-4.85, p<0.001) than patients with Lp(a) values <30 mg/dL. The low molecular-weight apo(a) phenotype was also associated with higher risk of both primary and secondary endpoints (3.57 (1.87-6.82) and 3.05 (2.00-4.62), respectively; p<0.001 for both), regardless of conventional risk factors and statins use. Conclusion In stable CHD patients Lp(a) concentration and low molecular-weight apo(a) phenotype are independently associated with three-fold increase in risk of major adverse cardiovascular events within 15 years after CABG. Lp(a) levels may provide an additional information for postoperative cardiovascular risk assessment.0Comments 7Citations
- "It is important to note that in the present investigation, the survival curves started to diverge after 5 years, which is pertinent because 5 years was the length of the follow-up period in previous trials exploring the role of Lp(a) levels and apo(a) phenotype in prognosis after CABG. The rate of survival free of major coronary events observed in the present study was very similar to that registered in the CABG arm of the randomized Medicine, Angioplasty, or Surgery Study (MASS II) . In a recent Japanese study, the authors enrolled 1074 consecutive patients who underwent CABG and followed them for 10 years; increased levels of non-HDL cholesterol were a significant and independent (of other lipid parameters) predictor of cardiac death . "