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Health-Related Quality of Life After Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in High-Risk Patients With Medically Refractory Ischemia - Health-Related Quality of Life After Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in High-Risk Patients With Medically Refractory Ischemia
Description:
The goal of this study was to assess the difference between the six-month health-related quality-of-life (HRQL) for high-risk patients with medically refractory ischemia randomized to percutaneous coronary intervention (PCI) versus coronary artery bypass graft surgery (CABG).
Study Design
Study Design:
Primary Endpoints:
Physical Component Summary (PCS) and Mental Component Summary (MCS)
Drug/Procedures Used:
Patients enrolled in a Veterans Affairs multicenter randomized trial comparing PCI versus CABG for patients with medically refractory ischemia and one or more risk factors for adverse outcome; who were alive at six months (389/423 [92%] after randomization completed an Short Form-36 (SF-36) health status survey. Primary outcomes of interest were the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36 adjusted for over 20 baseline variables.
Principal Findings:
PCS scores (38.7 vs. 37.3 for PCI and CABG, respectively; p = 0.23) and MCS scores (45.5 vs. 46.1, p = 0.58) were similar in the two treatment arms. Even in multivariable models, there was no difference in HRQL for post-PCI versus post-CABG patients (for PCS, absolute difference =0.56 + standard error of 1.14, p=0.63; for MCS, absolute difference = -1.23 + 1.12, p = 0.27).
Interpretation:
Among patients, HQRL at six months in high-risk patients with medically refractory ischemia randomized to PCI versus CABG surgery are equivalent, decision-making regarding selection of a revascularization procedure for these patients should not be driven by this parameter. The decision to recommend PCI or CABG in high-risk patients with medically refractory ischemia should be based on patients’ characteristics (CABG for diabetic patients or those with left main disease or three vessel disease with left ventricular dysfunction), local experience and success of the two revascularization procedures as well as patient preference in view of the similar mortality for PCI and CABG.
References:
Rumsfeld JS, Magid DJ, Plomondon ME et al, for the Department of Veterans Affairs Angina With Extremely Serious Operative Mortality (AWESOME) Investigators. Health-Related Quality of Life After Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in High-Risk Patients With Medically Refractory Ischemia. J Am Coll Cardiol 2003;41:1732– 1738.
Keywords: Quality of Life, Coronary Artery Bypass, Health Status, Angioplasty, Balloon, Coronary, Ventricular Dysfunction, Left, Patient Preference, Diabetes Mellitus, Percutaneous Coronary Intervention
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