Health-related quality of life outcomes of patients with coronary artery disease treated with cardiac surgery, percutaneous coronary intervention or medical management.
BACKGROUND
Given the repeated findings of little or no difference in mortality outcomes between percutaneous coronary intervention (PCI) with or without stent and coronary artery bypass graft surgery (CABG), there is a need to assess the health-related quality of life (HRQOL) outcomes associated with revascularization decisions.


OBJECTIVE
To compare risk-adjusted HRQOL outcomes by treatment strategy one year following cardiac catheterization.


METHODS
Using an inception cohort study design, the sample included all Alberta residents, 18 years of age or older, referred for cardiac catheterization, from January 1, 1996, to December 31, 1998, with two or more diseased coronary vessels at catheterization. Patients received a follow-up questionnaire including the Seattle Angina Questionnaire (SAQ), one year following their index catheterization. The SAQ comprises five dimensional scales measuring exertional capacity, anginal stability, anginal frequency, treatment satisfaction and quality of life.


RESULTS
Three thousand three hundred ninety-two (78.1%) patients responded to the follow-up survey. Responders who were revascularized consistently reported significantly better HRQOL compared with responders treated with medical management. Responders undergoing CABG reported significantly better HRQOL in all but one SAQ dimension compared with responders who had either a PCI with or without stent. Responders who had a PCI with stent reported better HRQOL compared with responders who underwent a PCI without a stent.


CONCLUSIONS
The treatment decision to revascularize the coronary vessels, whether with PCI with or without a stent or with CABG, was consistently associated with significantly better HRQOL at one-year follow-up compared with patients treated with medical therapy.
Norris
Colleen M
CM
Faculty of Nursing, University of Alberta, Edmonton, Canada. colleen.norris@nurs.ualberta.ca
Saunders
L Duncan
LD
Ghali
William A
WA
Brant
Rollin
R
Galbraith
P Diane
PD
Graham
Michelle
M
Faris
Peter
P
Dzavik
Vladimir
V
Knudtson
Merril L
ML
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D009864:Ontario; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome