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

• Published in: Circulation (New York, N.Y.) Vol. 122; no. 10; pp. 949 - 957
• Main Authors: HUEB, Whady, LOPES, Neuza, GERSH, Bernard J, SOARES, Paulo R, RIBEIRO, Expedito E, PEREIRA, Alexandre C, FAVARATO, Desiderio, ROCHA, Antonio Sérgio C, HUEB, Alexandre C, RAMIRES, Jose A. F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 07.09.2010
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Angioplasty, Balloon, Coronary - mortality; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Calcium Channel Blockers - therapeutic use; Cardiology. Vascular system; Coronary Artery Bypass - mortality; Coronary Artery Disease - drug therapy; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Disease-Free Survival; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Proportional Hazards Models; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vasodilator Agents - therapeutic use; Bypass; drugs; Surgery; heart diseases; Controlled therapeutic trial; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Survival; angioplasty
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.109.911669

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. ISRCTN66068876.