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Quality of Life After PCI With Drug-Eluting Stents or Coronary-Artery Bypass Surgery
Study Questions:
What is the relative improvement in quality of life of patients undergoing coronary artery bypass surgery (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES)?
Methods:
The authors reported the quality of life data for the SYNTAX study. In this large multicentric trial, 1,800 patients with three-vessel or left main coronary artery disease were randomized to undergo CABG or PCI with paclitaxel-eluting stent. The Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were used to assess health-related quality of life at baseline and at 1, 6, and 12 months. The primary endpoint for this analysis was the score on the angina-frequency subscale of the SAQ, with higher scores corresponding to better health status.
Results:
Both revascularization strategies were associated with significant improvement in quality of life at 6 and 12 months. There was no difference in freedom from angina at 1 month between PCI and CABG groups, whereas it was slightly higher with CABG at 12 months (76.3% vs. 71.6%, p = 0.05). CABG was associated with a greater increase in the score on the angina-frequency subscale of the SAQ at 6 months (p = 0.04) and 12 months (and p = 0.03), but this was driven by small differences between the two groups (mean treatment effect of 1.7 points at both time points). Scores on almost all other SAQ and SF-36 subscales were higher with PCI at 1 month and were similar at 6 months and beyond.
Conclusions:
Compared with PCI, CABG is associated with greater relief from angina in patients with three-vessel or left main coronary artery disease at 6 and 12 months.
Perspective:
The 3-year follow up from the SYNTAX trial suggests that there is no difference in outcome with PCI or CABG in patients with low SYNTAX score, while the outcome is better with CABG in those with intermediate or high SYNTAX scores (http://www.syntaxscore.com). This study suggests that both revascularization strategies are associated with an improvement in quality of life. Although CABG was associated with a small but significant improvement in angina at 6 and 12 months, this was offset by the rapid recovery and improved health status at 30 days with PCI.
Keywords: Follow-Up Studies, Drug-Eluting Stents, Coronary Artery Bypass, Cardiac Surgical Procedures, Stents, Percutaneous Coronary Intervention
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