A comparison of the recovery of health status after percutaneous coronary intervention and coronary artery bypass.
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.
Borkon
A Michael
AM
Mid America Heart Institute, Kansas City, Missouri, USA. mborkon@saint-lukes.org
Muehlebach
Gregory F
GF
House
John
J
Marso
Steven P
SP
Spertus
John A
JA
D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000401:mortality / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation / Q000401:mortality; D015607:Stents; D015996:Survival Rate