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Letters to the Editor |
Heart Institute of University of São Paulo, Brazil
Received 16 May 2008; accepted 21 May 2008.
* Corresponding author. Address: Av. Dr. Eneas de Carvalho Aguiar #44, Cerqueira Cesar, Sao Paulo, SP 05403-000, Brazil. Tel.: +55 11 3069 5032; fax: +55 11 3069 5188. (Email: mass{at}incor.usp.br).
Key Words: Angioplasty • CABG • Medical treatment
We are very pleased by the interest shown in our paper Impact of number of vessels disease on outcome of patients with stable coronary artery disease: 5-year follow-up of medical, angioplasty and bypass surgery study [1] by these distinguished authors [2]. We further analyzed our data as suggested:
First question: When PCI was compared to CABG, new revascularization procedure was performed in 29.4% on PCI vs 2.4% on CABG group (p < 0.01) and 23.3% on PCI vs 3.4% CABG (p < 0.01) in 2VD and 3VD, respectively. Indeed, the need of further revascularization increases health cost at the same survival benefits, as we have shown previously [2].
Second question: To rule out the selection bias, we found no statistical difference among the main characteristics (gender, age, hypertension, diabetes, smoking, previous MI, cholesterol, HDL, LDL, triglycerides levels, and positive treadmill test) stratified by groups (SVD, 2VD and 3VD) in each of the allocated treatment. So, there was a balance of the traditional risk factors among groups.
Third question: We compared the number of patients alive (A) vs cardiac related (CRD) vs non-cardiac related death (NCRD) on SVD (200, 9, 5), 2VD (222, 21, 10) and 3VD (294, 44, 20). We found higher cardiac related deaths on 3VD group (p = 0.004). However, we would like to highlight that the higher risk for death found in 3VD patients were adjusted for age and other comorbid variables, and consequently, the 3VD itself in an independent risk for death. When the 3VD group was stratified by treatment allocation, no statistical differences were noted among PCI (A = 101, CRD = 15, NCRD = 4), CABG (A = 96, CRD = 12, NCRD = 10), and MT (A = 97, CRD = 17, NCRD = 6) (p = 0.43). The main cause of death in PCI and MT was cardiac related, while in CABG group, cardiac and non-cardiac causes were balanced.
Finally, around 80% of our patients were under lipid lowering drugs and the values achieved after 60 months follow-up regarding cholesterol (PCI = 209[46], CABG = 213[46], MT = 212[47], p = 0.52) LDL (PCI = 131[40], CABG = 136[38], MT = 136[39], p = 0.31), HDL (PCI = 43[11], CABG = 43[11], MT = 42[10], p = 0.29), and triglycerides (PCI = 173[93], CABG = 162[91], MT = 186[162], p = 0.35) were balanced respectively, without being statistically different among treatment groups. We would like to stress that along the period of study follow-up, the lipid targets were different than currently used. Thus, we cannot make any conclusion based on the benefits of lipid treatment, since the values were similar and above the expected target. Thank you, indeed the correct cholesterol unit is mg/dl.
References
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