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Had been recommended for treatment with percutaneous revascularization. The patients were asymptomatic or had Canadian Cardiovascular Society CCS ; class I or II angina four patients had more severe angina ; and were able to complete at least four minutes of a treadmill test conducted according to the Bruce protocol or a bicycle exercise test at 20 W per minute without marked electrocardiographic changes indicative of ischemia.7-9 Major criteria for exclusion from the study were left main coronary artery disease, triple-vessel disease, unstable angina or myocardial infarction within the previous two weeks, and an ejection fraction of less than 40 percent. Informed consent was obtained from the study patients, and the research protocol was approved by the appropriate institutional review boards. Treatment The patients were stratified according to whether they had singleor double-vessel disease defined as stenosis of 50 percent or more in one or two coronary arteries, respectively ; and were then randomly assigned either to receive medical treatment with 80 mg of atorvastatin Lipitor, Parke-Davis, Ann Arbor, Mich. ; per day or to undergo the recommended percutaneous revascularization procedure angioplasty ; , followed by usual care, which could include lipid-lowering treatment. There was no washout period for patients already receiving lipid-lowering medication. Patients assigned to receive atorvastatin discontinued any other lipid-lowering medication they might have been taking and began taking atorvastatin 80 mg per day ; , whereas patients assigned to angioplasty and usual care were allowed to continue their current drug regimen. Statistical Analysis An independent end-points committee, the members of which were unaware of the treatment assignments, reviewed all ischemic events, and all analyses were based on the committee's classification of ischemic events. The CochranMantelHaenszel test, with stratification according to the participating center and the extent of disease, was used in an intention-to-treat analysis to compare the two treatment groups in regard to the proportion of patients with ischemic events. We defined an ischemic event as at least one of the following: death from cardiac causes, resuscitation after cardiac arrest, nonfatal myocardial infarction, cerebrovascular accident, coronaryartery bypass grafting, angioplasty, and worsening angina with objective evidence resulting in hospitalization. We used a Cox proportional-hazards analysis and KaplanMeier curves to examine the time to a first ischemic event. The sample size was planned to provide the study with 85 percent power, with a two-sided level of significance of 5 percent for the detection of a difference between treatment groups in the proportion of patients with ischemic events. Assumptions included event rates of 20 percent and 35 percent over a period of 18 months in the atorvastatin and angioplasty groups, respectively. Because of concern about the safety of patients not undergoing percutaneous revascularization as the initial treatment, we performed two interim analyses, using the O'BrienFleming stopping rule. Consequently, the significance level for the final analysis of the incidence of ischemic events was adjusted from 5 percent to 4.5 percent.10 All remaining variables were tested with a 5 percent level of significance and loestrin.

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Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minn. Adviser to resident and Consultant in Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minn. See end of article for correct answers to questions. Individual reprints of this article are not available. Address correspondence to Thomas F. Mangan, MD, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905 e-mail: mangan.thomas mayo ; . 2006 Mayo Foundation for Medical Education and Research and mescaline!

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