Five-Year Follow-Up of the Argentine Randomized Trial of Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease (ERACI II)

• Published in: Journal of the American College of Cardiology 2005-08, Vol.46 (4), p.582-588
• Main Authors: Rodriguez, Alfredo E., Baldi, Julio, Pereira, Carlos Fernández, Navia, Jose, Alemparte, Máximo Rodriguez, Delacasa, Alejandro, Vigo, Federico, Vogel, Daniel, O'Neill, William, Palacios, Igor F.
• Format: Article
• Language: English
• Subjects: Age Factors; Angioplasty; Angioplasty, Balloon, Coronary; Cardiology; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease - physiopathology; Coronary Artery Disease - surgery; Coronary Artery Disease - therapy; Coronary vessels; Female; Follow-Up Studies; Heart attacks; Hospitals; Humans; Male; Middle Aged; Mortality; Prognosis; Prospective Studies; Reoperation; Stents; Survival Analysis; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.12.081

The purpose of the present study is to report the five-year follow-up results of the ERACI II trial. Immediate and one-year follow-up results of the ERACI II study showed a prognosis advantage of percutaneous coronary intervention (PCI) with stents over coronary artery bypass grafting (CABG). A total of 450 patients were randomly assigned to undergo either PCI (n = 225); or CABG (n = 225). Only patients with multi-vessel disease were enrolled. Clinical follow-up during five years was obtained in 92% of the total population after hospital discharge. The primary end point of the study was to compare freedom from major adverse cardiovascular events (MACE) at 30 days, 1 year, 3 years, and 5 years of follow-up. At five years of follow-up, patients initially treated with PCI had similar survival and freedom from non-fatal acute myocardial infarction than those initially treated with CABG (92.8% vs. 88.4% and 97.3% vs. 94% respectively, p = 0.16). Freedom from repeat revascularization procedures (PCI/CABG) was significantly lower with PCI compared with CABG (71.5% vs. 92.4%, p = 0.0002). Freedom from MACE was also significantly lower with PCI compared with CABG (65.3% vs. 76.4%; p = 0.013). At five years similar numbers of patients randomized to each revascularization procedure were asymptomatic or with class I angina. At five years of follow-up, in the ERACI II study, there were no survival benefits from any revascularization procedure; however patients initially treated with CABG had better freedom from repeat revascularization procedures and from MACE.