***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 — A Department of Veterans Affairs Cooperative Study r and omized high-risk patients with medically refractory myocardial ischemia , a group largely excluded from previous trials , to urgent revascularization with either  percutaneous coronary intervention ( PCI ) or coronary artery bypass grafting ( CABG ) . The present study examined the cost-effectiveness of PCI versus CABG for these high-risk patients . Methods and Results — Of 454 patients at 16 Department of Veterans Affairs medical centers , 445 were available for the economic analysis ( 218 PCI and 227 CABG patients ) .  Total costs were assessed at 3 and 5 years from the third-party payer ’s perspective , and effectiveness was measured by survival . After 3 years , average total costs were $ 63 896 for PCI versus $ 84 364 for CABG patients , a difference of $ 20 468 ( 95 % confidence interval [ CI ] $ 13 918 to $ 27 569 ) . CIs were estimated by bootstrapping . Survival at 3 years was 0.82 for PCI versus 0.79 for CABG patients ( P=0.34 ) . Precision of the cost-effectiveness estimates were assessed by bootstrapping . PCI was less costly and more effective at 3 years in 92.6 % of the bootstrap replications . After 5 years , average total costs were $ 81 790 for PCI versus $ 100 522 for CABG patients , a difference of $ 18 732 ( 95 % CI $ 9873 to $ 27 831 ) , whereas survival at 5 years was 0.75 for PCI patients versus 0.70 for CABG patients ( P=0.21 ) . At 5 years , PCI remained less costly and more effective in 89.4 % of the bootstrap replications . Conclusions — PCI was less costly and at least as effective for the urgent revascularization of medically refractory , high-risk patients over 5 years BACKGROUND The natural history of atherosclerosis progression following revascularization procedures ( PTCA or CABG )  limits the long-term benefits of these procedures and requires continuation of risk management . MATERIAL / METHODS Of 392 patients with multivessel disease r and omized to an initial strategy of PTCA or CABG in the Emory Angioplasty Versus Surgery Trial ( EAST ) , 298 patients ( 152 PTCA and 146 CABG ) completed 3-year angiographic follow-up . Native coronary artery disease progression was defined as lesions with < 50 % diameter stenosis ( % S ) at baseline , measured by QCA , that increased at least 10%S to become > or=50%S during the 3-year follow-up . Major ischemic events ( new Q-wave myocardial infa rct ion , a large reversible thallium defect or additional revascularization procedures ) attributed to these new lesions were determined based on the ECG ischemic changes and /or the details of the coronary anatomy . RESULTS Of 298 patients , 53 ( 18 % ) ( 15 % of PTCA and 21 % of CABG ) developed at least one significant new native coronary artery lesion . Of 136 patients with events , 19 ( 14 % ) had such events due to progression . In multivariate analysis , native coronary disease progression was independently correlated with hypertension ( OR=2.4 , p=0.03 ) , ST segment depression = 1 mm on baseline ETT ( OR=2.7 , p=0.01 ) , and percent of small LDL particles ( LDL IIIa-IVb ) ( OR=1.2 for every 5 % increase , p=0.01 ) . CONCLUSIONS In EAST , the native CAD progression accounted for one in seven major ischemic episodes over a 3-year follow-up . Patients with metabolic atherogenic risk profiles were more likely to have disease progression . These findings indicate the importance of more aggressive risk factor modification following revascularization BACKGROUND Risks of coronary artery bypass graft surgery ( CABG ) or percutaneous transluminal coronary angioplasty ( PTCA ) may be different in the presence of peripheral vascular disease ( PVD ) . METHODS AND RESULTS We analyzed outcomes of 550 patients with PVD enrolled in the Bypass Angioplasty Revascularization Investigation r and omized trial and registry . Compared with 1770 patients without PVD , those with PVD were older and had a greater prevalence of medical comorbid conditions . No significant differences in coronary anatomy or PTCA success rates were found . The risk of any major complication ( death , myocardial infa rct ion , stroke , coma , or emergency revascularization ) after PTCA was significantly higher among patients with PVD ( 11.7 % versus 7.8 % , P=0.027 ) . In multivariate analysis , this represented a 50 % increase in the odds of having any major complication ( multivariate odds ratio , 1.5 ; P=0 . 032 ) . Among patients undergoing CABG , the risk of major complications was found to be markedly higher for patients with PVD ( 12 % ) than those without ( 6.1 % , P=0.003 ) even after controlling for baseline differences ( multivariate odds ratio , 1.8 ; P=0.018 ) . Major differences between the PTCA and CABG groups were related primarily to a higher risk of neurological complications in PVD patients who had CABG ( multivariate odds ratio , 2.8 ; P<0.001 ) . CONCLUSIONS We conclude that patients with PVD are at high risk for periprocedural complications after myocardial revascularization , in particular neurological events 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 —Although severe chronic kidney disease ( CKD ) is an independent predictor of mortality among patients with coronary artery disease , the impact of mild CKD on morbidity and mortality has not been fully defined . Methods and Results —Morbidity and mortality for the 3608 patients with multivessel coronary artery disease enrolled in the Bypass Angioplasty Revascularization Investigation r and omized trial and registry were compared on the basis of the presence and absence of CKD , defined as a preprocedure serum creatinine level of > 1.5 mg/dL. Seventy-six patients had CKD . Patients with renal insufficiency were older and more likely to have a history of diabetes , hypertension , and other comorbidities . Among patients undergoing PTCA , patients with CKD had a greater frequency of in-hospital death and cardiogenic shock ( P < 0.05 and 0.01 , respectively ) . There was a trend toward a larger proportion of patients with CKD experiencing angina at 5 years ( P = 0.079 ) . Patients with CKD had more cardiac admissions ( P = 0.003 and < 0.0001 for patients undergoing PTCA and CABG , respectively ) and a shorter time to subsequent CABG after initial revascularization than patients without CKD ( P = 0.01 ) . CKD was associated with a higher risk of death at 7 years , both of all causes ( relative risk 2.2 , P < 0.001 ) and of cardiac causes ( relative risk 2.8 , P < 0.001 ) . Conclusions —CKD is associated with an increased risk of recurrent hospitalization , subsequent CABG , and mortality . This increased risk of death is independent of and additive to the risk associated with diabetes BACKGROUND The impact of percutaneous transluminal coronary angioplasty ( PTCA ) and coronary artery bypass grafting ( CABG ) on long-term mortality rates in the presence of various demographic , clinical , and angiographic factors is uncertain in the population of patients suitable for both procedures . METHODS AND RESULTS In the Bypass Angioplasty Revascularization Investigation ( BARI ) r and omized trial and registry , 3610 patients who were eligible to receive PTCA and CABG were revascularized between 1989 and 1992 . Multivariate Cox models were used to identify factors associated with 5-year mortality and cardiac mortality , with particular attention to factors that interact with treatment . Diabetic patients receiving insulin had higher mortality and cardiac mortality rates with PTCA compared with CABG ( relative risk [ RR ] 1.78 and 2.63 , respectively , P<0.001 ) , and patients with ST elevation had higher cardiac mortality rates with CABG than with PTCA ( RR 4.08 , P<0.001 ) . Factors most strongly associated with high overall mortality rates were insulin-treated diabetes , congestive heart failure , kidney failure , and older age . Black race was also associated with higher mortality rates ( RR 1.49 , P=0.019 ) . CONCLUSIONS A set of variables was identified that could be used to help select a revascularization procedure and to evaluate risk of long-term mortality in the population of patients considering revascularization 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 —Coronary bypass surgery ( CABG ) and angioplasty ( PTCA ) have been compared in several r and omized trials , but data about long-term economic and quality -of-life outcomes are limited . Methods and Results —Cost and quality -of-life data were collected prospect ively from 934 patients who were r and omized in the Bypass Angioplasty Revascularization Investigation ( BARI ) and followed up for 10 to12 years .  CABG had 53 % higher costs initially , but the gap closed to < 5 % during the first 2 years ; after 12 years , the mean cumulative cost of CABG patients was $ 123 000 versus $ 120 750 for PTCA , yielding a cost-effectiveness ratio of $  
    Output:
    
However , the comparative effectiveness of CABG and PCI remains poorly understood for patients in whom both procedures are technically feasible and coronary revascularization is clinical ly indicated .
In patients with left main or triple-vessel coronary artery disease with reduced left ventricular function , CABG is generally preferred because r and omized , controlled trials ( RCTs ) have shown that it improves survival compared with medical therapy ( 2 , 3 ) .