Quality of Life after PCI with drug-eluting stents or CABG

January 01, 0001

Quality of Life after PCI with drug-eluting stents or CABG

Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in greater relief from angina and improved quality of life. This randomized controlled trial with 1800 patients was undertaken to determine use of drug-eluting stents on these outcomes differs. They assigned 1800 patients with three- vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxel-eluting stents (903 patients). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months.

They found: "The scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months, but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 month and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs. 71.6%). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period."

The authors concluded: "Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small."

Individual preferences should be the most important factor in choice of PCI with drug-eluting stent vs CABG given the small differences in outcomes.

For the full abstract, click here.

N Engl J Med 364:1016-1026, 17 March 2011
© 2011 to the American Medical Association
Quality of Life after PCI with Drug-Eluting Stents or Coronary- Artery Bypass Surgery. David J. Cohen, Ben Van Hout, Patrick W. Serruys, et al. Correspondence to Dr. Cohen: [email protected]

Category: K. Circulatory. Keywords: percutaneous coronary intervention, PCI, drug-eluting stent, paclitaxel, coronary artery bypass grafting, CABG, quality of life, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 5 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.