Published online before print November 22, 2004, doi: 10.1161/01.CIR.0000148366.80443.2B
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(Circulation. 2004;110:3411-3417.)
© 2004 American Heart Association, Inc.
Cardiovascular Surgery |
Neuropsychological Outcome After Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting
Results From the Stent or Surgery (SoS) Trial
From Sahlgrenska University Hospital, Gothenburg, Sweden (P.W.); Royal Brompton Hospital, London, UK (J.E.B., F.N., J.P.); London School of Hygiene and Tropical Medicine, London, UK (T.C.); Emory University School of Medicine, Atlanta, Ga (W.S.W.); University of Geneva, Geneva, Switzerland (U.S.); and Cardiothoracic Centre, Liverpool, UK (R.H.S.).
Correspondence to Peter Währborg, MD PhD, Department of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg. Sweden. E-mail peter.wahrborg{at}hjl.gu.se
Received April 19, 2004; revision received September 1, 2004; accepted September 10, 2004.
Background— Coronary artery bypass surgery (CABG) has been associated with a range of neurological and neuropsychological complications from stroke to cognitive problems such as memory and problem solving disturbance. However, little is known about the impact of percutaneous coronary intervention (PCI) on neuropsychological outcome.
Methods and Results— In the Stent or Surgery Trial (SoS), 988 patients were randomized in equal proportions between PCI supported by stent implantation and CABG. As a substudy of this trial, we undertook an evaluation of neurological and neuropsychological outcomes after intervention. A clinical examination and neuropsychological assessment consisting of 5 tests (Digit Span Forwards and Backwards, Visual Reproduction, Bourdon, and Block Design) were performed at baseline and 6 and 12 months after the procedure. A total of 145 patients were included in the substudy analysis: 77 in the PCI group and 68 in the CABG group. One patient in the PCI arm had a stroke. There was no significant difference between treatment groups at 6 and 12 months for any of the 5 tests. The mean change from baseline was also similar in both groups.
Conclusions— We were not able to demonstrate an important and significant difference in neuropsychological outcome in patients treated with different revascularization strategies. This important finding needs to be examined in further research.
Key Words: angioplasty • cognition • bypass, coronary artery • neuropsychology • stents
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