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Randomised controlled trial
Coronary artery surgery for multivessel coronary artery disease reduces 10-year risk of myocardial infarction compared with medical treatment or percutaneous coronary intervention
  1. Vankeepuram S Srinivas,
  2. Seshasayee Narasimhan
  1. Division of Cardiology, Montefiore Medical Center, New York, USA
  1. Correspondence to Vankeepuram S Srinivas
    1825 Eastchester Road, Suite W1-120, Bronx, NY 10461, USA; vsriniva{at}montefiore.org

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Context

Management of multivessel coronary artery disease (CAD) continues to evolve with advances in medical therapy, percutaneous coronary revascularisation (PCI) techniques and coronary artery bypass grafting (CABG). Among the several randomised comparisons of these therapies1,,5 is the medicine, angioplasty or surgery study (MASS II) that reported their 10-year results recently.

Methods

Patients in MASS II had multivessel CAD with >70% diameter stenosis in proximal vessels and documented ischemia. Important exclusion criteria were left ventricular ejection fraction <40%, prior revascularisation and left main stenosis ≥50%. Patients were randomised to medical therapy, surgery or PCI. Medical therapy included individualised combination of nitrates, aspirin, β blockers, calcium channel blockers and statins; PCI was performed within 3 and CABG within 12 weeks of assignment and patients were followed up every 6 months for 10 years. Predefined end points were the incidence of mortality, Q-wave myocardial infarction (MI) or refractory angina requiring revascularisation. …

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