Myocardial Revascularization in Multiple Coronary Blockade: Evidences from Randomized Argentine Studies (ERACI I and ERACI II)

pp 653-661

Abstract

Angioplasty and myocardial revascularization surgery in patients with multiple vessel disease have been previously compared in many randomized studies. These studies performed without the aidof new devices showed lower recurrence of symptoms and extended survival in diabetic patients treated with surgery.

The employment of new techniques as coronary angioplasty, especially with stent, makes it necessary to perform an updated comparison of both revascularization techniques. Two randomized studies were performed in Argentina: ERACI I and ERACI II. ERACI I recruited patients between 1988-1999 and ERACI II between 1997-1998. ERACI I compared conventional angioplasty with balloon vs surgery in patients with multiple vessel disease and ERACI II compare angioplasty with stent in the patients versus coronary surgery, also in patients with multiple vessel disease (91% of the included patients were in unstable angina of classes II-II-C).

ERACI I showed no differences in morbidity and mortality between both procedures, but disclosed a larger group of subjects with angioplasty requiered a new revascularization procedure.On the other hand ERACI II (a multicentric study with a mean of 1.4 stent per patient in the subjects randomized to angioplasty) and nearly 30% of drugs inhibiting glycoproteins Ilb and Illa showed less incidence of major cardiac adverse events inpatients with angioplasty, compared to the operated ones. These initial benefits were sustained one year after the procedure. The ERACI II study also revealed that patients revascularized by angioplasty with stent required new revascularization practices more frequently than operated patients, according to previous results.

Conclusion: In unstable patients with multiple vessel disease the procedure, angioplasty with stent and Reopro usage exhibited less incidence of cardiac adverse events than conventional surgery, 30 days after. These benefits were still apparent at one-year follow-up.