For patients with both diabetes and multivessel coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery provides slightly better short and intermediate health status and quality of life as compared to percutaneous coronary intervention (PCI), but there was no significant long-term difference between the two procedures, according to a sub-study conducted alongside the FREEDOM trial published Oct. 15 in the Journal of the American Medical Association.

The FREEDOM trial looked at 1,900 patients from 18 countries and found that CABG offers better survival and MI outcomes that PCI using drug-eluting stents, but rates of stroke are higher with CABG and there is a longer recovery period than PCI. According to the prospective health status sub-study, CABG produced slightly better scores for angina and functional status at six months (p=0.002) and 12 months (p=0.03), but there was no difference between the two treatments from two years through the end of the five-year follow-up period. The authors also noted similar quality-of-life outcomes were achieved with higher rates of antianginal medication use, as well as a need for more frequent repeat revascularization procedures among the PCI group.

"Patients experienced substantial and durable improvements in cardiovascular-specific health status following both PCI and CABG," said lead author Mouin Abdallah, MD, MSc, Saint Luke's Mid American Heart Institute, Kansas City, MO. "PCI resulted in more rapid improvement, [but] these improvements were largely restricted to the first month. Between six months and two years, health status was slightly better with CABG. Beyond two years, there were no consistent differences in any health status or quality of life domains between the CABG and PCI strategies."

Given that CABG showed the greatest advantage in angina relief for patients with the most severe symptoms at baseline, the authors suggest that CABG be strongly preferred as the initial revascularization strategy. However, they note that given the increased rate of stroke, as well as the well-recognized longer recovery period with CABG surgery, some patients who do not wish to face these acute risks may still choose the less invasive PCI strategy. "For such patients, our study provides reassurance that there are not major differences in long-term health status and quality of life between the two treatment strategies," the authors said.

Keywords: Coronary Artery Disease, Stroke, Follow-Up Studies, Drug-Eluting Stents, Quality of Life, Health Status, Coronary Artery Bypass, Diabetes Mellitus, Percutaneous Coronary Intervention