Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials

Background Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are alternative treatments for multivessel coronary disease. Although the procedures have been compared in several randomised trials, their long-term effects on mortality in key clinical subgroups are uncertain. We undertook a collaborative analysis of data from randomised trials to assess whether the effects of the procedures on mortality are modified by patient characteristics. Methods We pooled individual patient data from ten randomised trials to compare the effectiveness of CABG with PCI according to patients' baseline Clinical Characteristics. We used stratified, random effects Cox proportional hazards models to test the effect on all-cause mortality of randomised treatment assignment and its interaction with clinical characteristics. All analyses were by intention to treat. Findings Ten participating trials provided data on 7812 patients. PCI was done with balloon angioplasty in six trials and with bare-metal stents in four trials. Over a median follow-up of 5.9 years (IQR 5.0-10.0), 575 (15%) of 3889 patients assigned to CABG died compared with 628 (16%) of 3923 patients assigned to PCI (hazard ratio [HR] 0.91, 95% CI 0.82-1.02; p=0.12). In patients with diabetes (CABG, n=615; PCI, n=618), mortality was substantially lower in the CABG group than in the PCI group (HR 0.70, 0.56-0.87); however, mortality was similar between groups in patients without diabetes (HR 0.98, 0.86-1.12; p=0.014 for interaction). Patient age modified the effect of treatment on mortality, with hazard ratios of 1.25 (0.94-1.66) in patients younger than 55 years, 0.90 (0.75-1.09) in patients aged 55-64 years, and 0.82 (0.70-0.97) in patients 65 years and older (p=0.002 for interaction). Treatment effect was not modified by the number of diseased vessels or other baseline characteristics. Interpretation Long-term mortality is similar after CABG and PCI in most patient subgroups with multivessel coronary artery disease, so choice of treatment should depend on patient preferences for other outcomes. CABG might be a better option for patients with diabetes and patients aged 65 years or older because we found mortality to be lower in these subgroups

Human and climatic impact on mires: a case study of Les Amburnex mire, Swiss Jura Mountains

Modern period long-term human and climatic impacts on a small mire in the Jura Mountains were assessed using testate amoebae, macrofossils and pollen. This multiproxy data analysis permitted detailed interpretations of local and regional environmental change and thus a partial disentanglement of the different variables that influence long-term mire development. From the Middle Ages until a.d. 1700 the mire vegetation was characterised by ferns, Caltha and Vaccinium, but then abruptly changed into the modern vegetation characterised by Cyperaceae, Potentilla and Sphagnum. The cause for this change was most probably deforestation, possibly enhanced by climatic cooling. A decrease in trampling intensity by domestic animals from a.d. 1950 onwards allowed Sphagnum growth and climatic warming in the a.d. 1980s and 1990s may have been responsible for considerable changes in the species composition. The mire investigated is an example of the rapid changes in mire vegetation and peat development that occurred throughout the central European mountain region during the past centuries as a result of changing climate and land-use practice. These processes are still active today and will determine the future development of high-altitude mires