Health related quality of life after percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with acute coronary syndromes without ST-segment elevation. 12-month follow up.
OBJECTIVE
The efficacy of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation is similar. Therefore, other factors, like health-related quality of life, should play an important role in choosing the revascularization method.


METHODS
We compared 12-month health-related quality of life for high-risk patients with acute coronary syndromes without ST-segment elevation assigned to percutaneous coronary intervention (group A) versus coronary artery bypass graft surgery (group B). Patients had an episode of rest angina within 24h prior to admission and had to fulfil at least one of the criteria: (1) ST-segment depression (>or=0.05mV), (2) transient (<20min) ST-segment elevation or T-wave inversion (>or=0.1mV), (3) positive serum cardiac markers. Four hundred and ninety-six (91.34%) of 543 patients alive 12-months after index hospitalization completed a Short Form-36 (SF-36) health status survey. Group A comprised 392 patients and group B comprised 104 patients. We compared mental component summary (MCS) and physical component summary (PCS) scores from the SF-36 survey between analyzed groups.


RESULTS
There were no significant differences in MCS scores (47.21+/-12.30 vs. 46.60+/-11.3 in group A and group B, respectively, NS). PCS scores were lower in group A (38.30+/-11.10 vs. 42.64+/-9.76; p=0.003). Patients of group A had a higher rate of unstable angina (22.45 vs. 5.77%, p=0.0002) and repeated revascularization (12.76 vs. 1.92%, p=0.001) at 1 year. Patients of group A also had higher systolic and diastolic blood pressure during follow-up (138.17+/-20.41 vs. 133.47+/-19.21, p=0.04 and 82.48+/-11.32 vs. 77.25+/-16.17, p=0.0003, respectively). Systolic blood pressure was inversely associated with PCS scores in group A (Spearman's R= -0.18 p=0.0007).


CONCLUSIONS
This study has shown that there is a significant difference in health-related quality of life 12-months after percutaneous coronary intervention and coronary artery bypass graft surgery. This difference arises from better physical function (physical component summary) for coronary artery bypass graft surgery patients compared with percutaneous coronary intervention patients. Despite impairment of the physical health status (physical component summary), the mental health status (mental component summary) remained similar in both groups.
Szygula-Jurkiewicz
Bozena
B
3rd Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Szpitalna 2 Street, 41-800 Zabrze, Poland. b.szygula@sccs.pl <b.szygula@sccs.pl>
Zembala
Marian
M
Wilczek
Krzysztof
K
Wojnicz
Romuald
R
Polonski
Lech
L
D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010063:Ovum; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012086:Reoperation; D016896:Treatment Outcome