title: Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery.
abstract: BACKGROUND
  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. The effect of PCI with the use of drug-eluting stents on these outcomes is unknown.
  
  
  METHODS
  In a large, randomized trial, we 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 with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary end point was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status).
  
  
  RESULTS
  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 (P=0.04 and P=0.03, respectively), 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%, P=0.05). 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.
  
  
  CONCLUSIONS
  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. (Funded by Boston Scientific; ClinicalTrials.gov number, NCT00114972.).
authors.affiliation: Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO 64111, USA. dcohen@saint-lukes.org
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Ben
authors.initials: B
authors.lastname: Van Hout
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Peter
authors.initials: P
authors.lastname: den Heijer
authors.forename: M M
authors.initials: MM
authors.lastname: Vrakking
authors.forename: Kaijun
authors.initials: K
authors.lastname: Wang
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Mahoney
authors.forename: Salma
authors.initials: S
authors.lastname: Audi
authors.forename: Katrin
authors.initials: K
authors.lastname: Leadley
authors.forename: Keith D
authors.initials: KD
authors.lastname: Dawkins
authors.forename: A Pieter
authors.initials: AP
authors.lastname: Kappetein
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires