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(Circulation. 2003;108:1694.)
© 2003 American Heart Association, Inc.

Clinical Investigations

Disease-Specific Health Status After Stent-Assisted Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery

One-Year Results From the Stent or Surgery Trial

Zefeng Zhang, MD, PhD; Elizabeth M. Mahoney, ScD; Rodney H. Stables, MD; Jean Booth, BSc, MSc; Fiona Nugara, BSc; John A. Spertus, MD, MPH; William S. Weintraub, MD

From the Division of Cardiology (Z.Z., E.M.M., W.S.W.), Emory University School of Medicine, Atlanta, Ga; Cardiothoracic Center Liverpool (R.H.S.), Liverpool, UK; Clinical Trials & Evaluation Unit (J.B., F.N.), Royal Brompton Hospital, London, UK; and Mid-America Heart Institute and the University of Missouri–Kansas City (J.A.S.), Kansas City, Mo.

Correspondence to William S. Weintraub, MD, Emory University School of Medicine, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306. E-mail wweintr{at}emory.edu

Received December 30, 2002; de novo received May 9, 2003; revision received June 26, 2003; accepted June 26, 2003.

Abstract

Background— Functional status and quality of life are important outcomes in the evaluation of revascularization approaches for symptomatic coronary artery disease. Few data are available regarding the comparative improvement in disease-specific health status after CABG versus percutaneous coronary intervention (PCI) in the era of coronary stenting.

Methods and Results— Cardiac-specific health status was evaluated at baseline and at 6 and 12 months after intervention with the Seattle Angina Questionnaire (SAQ) in patients randomized to stent-assisted PCI (n=488) versus CABG (n=500) in the Stent or Surgery trial. Scores for physical limitation, angina frequency, and quality of life improved significantly for both treatment groups at 6 months (range of improvement from 13.6 to 34.7 points) and 12 months (14.3 to 38.2 points; all P<0.001). CABG patients had greater improvement than those assigned to PCI, although the magnitude of the difference decreased over time (difference at 6 months, 4.03 to 6.48 points; 12 months, 2.05 to 2.93 points). A component of this reduction is accounted for by PCI-arm patients who required repeat intervention. Differences between treatment groups were greatest for the 6-month angina frequency scores (difference=6.48 points; 95% CI 3.96 to 8.99). Overall, treatment satisfaction was high and did not differ significantly between groups.

Conclusions— Both CABG and stent-assisted PCI dramatically improved cardiac-related health status in patients with multivessel disease at 6- and 12-month follow-up. During the first postprocedure year, patients’ angina burden and physical limitations were alleviated to a greater extent with CABG.

Key Words: angina • bypass • stents

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