13-year follow-up of the German Angioplasty Bypass Surgery Investigation (GABI)

Aims: The German Angioplasty Bypass Surgery Investigation (GABI) was designed to compare symptomatic efficacy and safety of percutaneous coronary angioplasty (PCI) and coronary artery bypass surgery (CABG) in patients with symptomatic multivessel disease. This follow-up was performed to determine the long-term outcome of patients undergoing these interventions.

Methods: From 1986 to 1991, 359 patients with angina CCS class II–IV, age below 75 years and coronary multivessel disease requiring revascularisation of at least 2 major coronary vessels were recruited at 8 German centers and randomized to PCI or CABG.

Results: From 337 patients finally undergoing the planned procedure, 307 patients from 7 out of 8 sites could be followed-up (91%). Baseline parameters were identical in both groups, 2.2±0.6 vessels were treated in CABG patients, while 1.9±0.5 vessels were treated in PCI patients. 37% of surgical patients received internal mammary artery grafts. At the end of the 13.6±1.5 year follow-up period, degree of angina, degree of dyspnoe and utilization of nitrates were identical in both groups. Kaplan-Meyer analysis revealed a comparable mortality distribution in both groups. While time to first reintervention was significantly shorter in patients undergoing PCI, p<0.001, frequencies of reintervention and crossover rates were comparable in both groups.

Conclusion: The results of our 13.6-year follow-up suggest, that in patients with symptomatic multivessel disease, both PCI and CABG are associated with a comparable long-term survival and symptomatic efficacy. In how far these results may be altered by developments such as drug eluting stents or new surgical techniques remains to be determined.