Elsevier

The Annals of Thoracic Surgery

Volume 74, Issue 5, November 2002, Pages 1526-1530
The Annals of Thoracic Surgery

Original article: cardiovascular
A comparison of the recovery of health status after percutaneous coronary intervention and coronary artery bypass

Presented at the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.
https://doi.org/10.1016/S0003-4975(02)04063-8Get rights and content

Abstract

Background

Selection of the optimum mode of coronary revascularization should not only be directed by technical outcomes, but should also consider patients’ postprocedural health status, including symptoms, functionality, and quality of life.

Methods

Health status was analyzed and compared after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using the Seattle Angina Questionnaire (SAQ). The SAQ was administered to 475 patients (252 PCI and 223 CABG) preprocedure and then monthly for 6 months and again at 1 year. Differences in baseline characteristics were controlled by multivariable risk adjustment, and outcomes over time were compared using repeated-measures analysis of variance.

Results

In-hospital, 6-and 12-month clinical outcomes were not different; however, 25% of PCI patients required at least one reintervention during the study period, compared with only 1% of CABG patients (p < 0.001). Although physical function decreased for CABG patients at 1 month (p < 0.001), it improved and was better than the PCI group by 12 months (p = 0.008). Relief of angina was greater for CABG than PCI when analyzed over time (p < 0.001), principally due to the adverse effects of restenosis in the PCI group. Multivariable analysis confirmed that CABG independently conferred greater angina relief compared with PCI (p < 0.001). At 12 months postprocedure, quality of life had improved to a greater extent for CABG than PCI (p = 0.004).

Conclusions

Over 12 months of follow-up, health status was improved to a greater extent for CABG patients than for PCI patients, primarily due to the adverse influence of restenosis after PCI.

Section snippets

Patients

Between February 8, 1999 and July 7, 1999, 495 patients undergoing coronary revascularization were consecutively entered into a study protocol approved by our institutional review board. Details of data collection and potential selection biases have been described previously [5]. Twenty patients from this initial cohort were excluded because the revascularization procedure (PCI) was performed as primary reperfusion for an evolving acute myocardial infarction. Thus, a total of 475 patients were

Results

Sociodemographic and clinical characteristics are shown in Table 1, Table 2, respectively. Patients undergoing CABG tended to be older (p < 0.01) and had a greater extent of anatomic disease, manifested by increased frequency of three-vessel and left main coronary artery disease (p < 0.0001) and a larger proportion of patients with an ejection fraction less than 40% (p < 0.05). In contrast, the PCI group had an increased proportion of patients with a history of prior PCI or CABG (p < 0.0001)

Comment

This observational registry demonstrates improved symptom control after CABG as compared with PCI, such that CABG patients were able to attain better physical function and quality of life 1 year after their procedure. This study is unique in that it is the first reported comparison of CABG and PCI to include a disease-specific measure of health status and because it carefully assessed health status throughout the entire year of recovery. The use of the SAQ allowed a sensitive assessment of the

Acknowledgements

This work was supported in part by an unrestricted grant from Pharmacia and, in part, by grant R-01 HS11282-01 from the Agency for Healthcare Research and Quality.

References (8)

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