***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease . METHODS A total of 1205 patients were r and omly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique . The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year . The costs of hospital re sources used were also determined . RESULTS At one year , there was no significant difference between the two groups in terms of the rates of death , stroke , or myocardial infa rct ion . Among patients who survived without a stroke or a myocardial infa rct ion , 16.8 percent of those in the stenting group underwent a second revascularization , as compared with 3.5 percent of those in the surgery group . The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery ( P<0.001 by the log-rank test ) . The costs for the initial procedure were $ 4,212 less for patients assigned to stenting than for those assigned to bypass surgery , but this difference was reduced during follow-up because of the increased need for repeated revascularization ; after one year , the net difference in favor of stenting was estimated to be $ 2,973 per patient . CONCLUSION As measured one year after the procedure , coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death , stroke , and myocardial infa rct ion . However , stenting is associated with a greater need for repeated revascularization Background —This investigation compares the results of contemporary percutaneous coronary intervention ( PCI ) with st and ard balloon angioplasty among patients with multivessel coronary disease . Patients having balloon angioplasty in the Bypass Angioplasty Revascularization Investigation ( BARI ) and those within the Dynamic Registry meeting BARI eligibility criteria were studied . Methods and Results — Clinical features and in-hospital and 1-year outcomes of 857 BARI-eligible patients in the Dynamic Registry ( contemporary PCI ) were compared with the 904 r and omized patients who underwent percutaneous transluminal coronary angioplasty in BARI .  Compared with BARI patients , Registry patients had fewer lesions attempted ( 1.53 versus 2.56 , P = 0.001 ) , more frequent single-vessel PCI ( 76 % versus 33 % , P < 0.001 ) , greater use of intracoronary stents ( 76 % versus 1 % , P < 0.001 ) , and GP IIb/IIIa receptor antagonist ( 24 % versus 0 % , P < 0.001 ) . Angiographic success was achieved more often among Registry patients ( 91 % versus 72 % , P < 0.001 ) , whereas abrupt closure ( 1.5 % versus 9.5 % , P < 0.001 ) and in-hospital coronary artery bypass graft ( CABG ) ( 1.9 % versus 10.2 % , P < 0.001 ) and myocardial infa rct ion ( 0.8 % versus 2.1 % , P = 0.025 ) were less common . No differences were observed in either in-hospital or 1-year death , but 1-year death/myocardial infa rct ion was lower in the Registry . Registry patients had lower 1-year rates of subsequent CABG ( 8.6 % versus 22.7 % , P < 0.001 ) and PCI ( 12.4 % versus 22.5 % , P < 0.001 ) . By multivariate analysis , contemporary PCI was independently associated with reduced risk for in-hospital CABG , 1-year CABG , and 1-year PCI . Conclusions —Among patients with multivessel disease , contemporary PCI result ed in safer and more durable revascularization . These results support the role of PCI for selected patients with multivessel coronary artery disease OBJECTIVES To compare the clinical - and cost-effectiveness of minimally invasive direct coronary artery bypass grafting ( MIDCAB ) and percutaneous transluminal coronary angioplasty ( PTCA ) with or without stenting in patients with single-vessel disease of the left anterior descending coronary artery ( LAD ) . DESIGN Multi-centre r and omised trial without blinding . The computer-generated sequence of r and omised assignments was stratified by centre , allocated participants in blocks and was concealed using a central ised telephone facility . SETTING Four tertiary cardiothoracic surgery centres in Engl and . PARTICIPANTS Patients with ischaemic heart disease with at least 50 % proximal stenosis of the LAD , suitable for either PTCA or MIDCAB , and with no significant disease in another vessel . INTERVENTIONS Patients r and omised to PTCA had local anaesthetic and underwent PTCA according to the method preferred by the operator carrying out the procedure . Patients r and omised to MIDCAB had general anaesthetic . The chest was opened through an 8 - 10-cm left anterior thoracotomy . The ribs were retracted and the left internal thoracic artery ( LITA ) harvested . The pericardium was opened in the line of the LAD to confirm the feasibility of operation . The distal LITA was anastomosed end-to-side to an arteriotomy in the LAD . All operators were experienced in carrying out MIDCAB . MAIN OUTCOME MEASURES The primary outcome measure was survival free from cardiac-related events . Relevant events were death , myocardial infa rct ion , repeat coronary revascularisation and recurrence of symptomatic angina or clinical signs of ischaemia during an exercise tolerance test at annual follow-up . Secondary outcome measures were complications , functional outcome , disease-specific and generic quality of life , health and social services re source use and their costs . RESULTS A total of 12,828 consecutive patients undergoing an angiogram were logged at participating centres from November 1999 to December 2001 . Of the 1091 patients with proximal stenosis of the LAD , 127 were eligible and consented to take part ; 100 were r and omised and the remaining 27 consented to follow-up . All r and omised participants were included in an intention-to-treat analysis of survival free from cardiac-related events , which found a non-significant benefit from MIDCAB .  Cumulative hazard rates at 12 months were estimated to be 7.1 and 9.2 % for MIDCAB and PTCA , respectively . There were no important differences between MIDCAB and PTCA with respect to angina symptoms or disease-specific or generic quality of life . The total NHS procedure costs were 1648 British pounds and 946 British pounds for MIDCAB and PTCA , respectively . The costs of re sources used during 1 year of follow-up were 1033 British pounds and 843 British pounds , respectively . CONCLUSIONS The study found no evidence that MIDCAB was more effective than PTCA . The procedure costs of MIDCAB were observed to be considerably higher than those of PTCA . Given these findings , it is unlikely that MIDCAB represents a cost-effective use of re sources in the reference population . Recent advances in cardiac surgery mean that surgeons now tend to carry out off-pump bypass grafting via a sternotomy instead of MIDCAB . At the same time , cardiologists are treating more patients with multi-vessel disease by PTCA . Future primary research should focus on this comparison . Other small trials of PTCA versus MIDCAB have now finished and a more conclusive answer to the original objective could be provided by a systematic review Purpose : To compare percutaneous coronary intervention ( PCI ) using stent implantation versus coronary artery bypass graft ( CABG ) in patients with multiple vessel disease with involvement of the proximal left anterior descending coronary artery ( LAD ) . Methods : 230 patients with multiple vessel disease and severe stenosis of the proximal LAD ( 113 with PCI , 117 with CABG ) . They were a cohort of patients from the r and omised ERACI ( Argentine r and omized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease ) II study . Results : Both groups had similar baseline characteristics . There were no significant differences in 30 day major adverse cardiac events ( death , myocardial infa rct ion , stroke , and repeat procedures ) between the strategies ( PCI 2.7 % v CABG 7.6 % , p = 0.18 ) . There were no significant differences in survival ( PCI 96.4 % v CABG 95 % , p = 0.98 ) and survival with freedom from myocardial infa rct ion ( PCI 92 % v CABG 89 % , p = 0.94 ) at 41.5 ( 6 ) months ’ follow up . However , freedom from new revascularisation procedures ( CABG 96.6 % v PCI 73 % , p = 0.0002 ) and frequency of angina ( CABG 9.4 % v PCI 22 % , p = 0.025 ) were superior in the CABG group . Conclusion : Patients with multivessel disease and significant disease of the proximal LAD r and omly assigned in the ERACI II trial to PCI or CABG had similar survival and survival with freedom from myocardial infa rct ion at long term follow up . Repeat revascularisation procedures were higher in the PCI group Background —Our aims were to compare coronary artery bypass grafting ( CABG ) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study ( ARTS ) trial and to determine the costs of these 2 treatment strategies . Methods and Results — Patients ( n=1205 ) were r and omly assigned to stent implantation  ( n=600 ; diabetic , 112 ) or CABG ( n=605 ; diabetic , 96 ) . Costs per patient were calculated as the product of each patient ’s use of re sources and the corresponding unit costs . Baseline characteristics were similar between the groups . At 1 year , diabetic patients treated with stenting had the lowest event-free survival rate ( 63.4 % ) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG ( 84.4 % , P < 0.001 ) and nondiabetic patients treated with stents ( 76.2 % , P = 0.04 ) . Conversely , diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG ( 84.4 % and 88.4 % ) . The total 1-year costs for stenting and CABG in diabetic patients were $ 12 855 and $ 16 585 ( P < 0.001 ) and in the nondiabetic groups , $ 10 164 for stenting and $ 13 082 for surgery . Conclusions —Multivessel diabetic patients treated with stenting  had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting . The strategy of stenting was less costly than CABG , however , regardless of diabetic status Background —Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina . Recent improvements in percutaneous treatment ( stent implantation ) and bypass surgery ( arterial grafts ) warrant reevaluation of the relative merits of either technique in treatment of unstable angina . Methods and Results —Seven hundred fifty-five patients with stable angina were r and omly assigned to coronary stenting ( 374 ) or bypass surgery ( 381 ) , and 450 patients with unstable angina were r and omly assigned to coronary stenting ( 226 ) or bypass surgery ( 224 ) . All patients had multivessel disease considered to be equally treatable by either technique . Freedom from major adverse events , including death , myocardial infa rct ion , and cerebrovascular events , at 1 year was not different in unstable patients ( 91.2 % versus 88.9 % ) and stable patients ( 90.4 % versus 92.6 % ) treated , respectively , with coronary stenting or bypass surgery .  Freedom from repeat revascularization at 1 year was similar in unstable and stable angina treated with stenting ( 79.2 % versus 78.9 % ) or bypass surgery ( 96.3 % versus 96 % ) but was significantly higher in both unstable and stable patients treated with stenting ( 16.8 % versus 16.9 % ) compared with bypass surgery ( 3.6 % versus 3.5 % ) . Neither the difference in costs between stented or bypassed stable or unstable angina ( $ 2594 versus $ 3627 ) nor the cost-effectiveness was significantly different at 1 year . Conclusions —There was no difference in rates of death , myocardial infa rct ion , and cerebrovascular event at 1 year in patients with unstable angina and multivessel disease treated with either stented angioplasty or bypass surgery compared with patients 
    Output:
    
No statistical differences were observed between CABG and stenting for meta- analysis of mortality or AMI , but there was heterogeneity .
Composite cardiac event and revascularisation rates were lower for CABG than for stents .
CABG is associated with reduced rates of major adverse cardiac events , mostly driven by reduced repeat revascularisation .
Research on real-world patient population or patient level data meta-analyses may identify risk factors and groupings who may benefit most from one strategy over the other