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(Circulation. 1996;94:135-142.)
© 1996 American Heart Association, Inc.
Articles |
Quality of Life, Employment Status, and Anginal Symptoms After Coronary Angioplasty or Bypass Surgery
3-Year Follow-up in the Randomized Intervention Treatment of Angina (RITA) Trial
the Medical Statistics Unit, London School of Hygiene and Tropical Medicine (S.J.P., P.S.); Cardiovascular Medicine, University Hospital, Nottingham (R.A.H., J.R.H.); and the Department of Cardiothoracic Surgery, St George's Hospital, London (T.T.), UK.
Correspondence to Professor Stuart J. Pocock, Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
Background The Randomized Intervention Treatment of Angina (RITA) trial compares initial policies of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG) in 1011 patients with angina. This report assesses the impact of these revascularization procedures on angina, quality of life (according to the Nottingham Health Profile), and employment over 3 years of follow-up.
Methods and Results Both interventions produced marked improvement in all quality-of-life dimensions (energy, pain, emotional reactions, sleep, social isolation, and mobility) and seven aspects of daily living. Patients with angina at 2 years had more quality-of-life impairment than angina-free patients, whose perceived health was similar to population norms. This reflects the close link at baseline between angina grade and quality of life. The slightly greater impairment of quality of life in PTCA compared with CABG patients is a result of their significantly higher chances of having angina, especially after 6 months. Employment status was investigated mainly for men 
60 years old. PTCA patients returned to work sooner (40% at 2 months compared with 10% of CABG patients), but the latter caught up by 5 months. After 2 years, 22% and 26% of CABG and PTCA patients, respectively, were not working for cardiac reasons. Patients with angina at 2 years were much more likely to be unemployed than those without.
Conclusions The impact of angina on quality of life and unemployment is greatly alleviated by PTCA or CABG. Angina is avoided more successfully with CABG, but PTCA offers a speedier return to work. Both intervention strategies then produce similar benefits for quality of life and employment over several years.
Key Words: angioplasty • trials • angina • bypass
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|
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|
|
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
 M. E. Charlson and O. W. Isom Care after Coronary-Artery Bypass Surgery N. Engl. J. Med., April 10, 2003; 348(15): 1456 - 1463. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
B Brorsson, S J Bernstein, R H Brook, and L Werko Quality of life of patients with chronic stable angina before and four years after coronary revascularisation compared with a normal population Heart, February 1, 2002; 87(2): 140 - 145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 R. Ecochard, C. Colin, M. Rabilloud, G. de Gevigney, D. Cao, C. Ducreux, F. Delahaye, and PRIMA group Indicators of myocardial dysfunction and quality of life, one year after acute infarction Eur J Heart Fail, October 1, 2001; 3(5): 561 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. TREASURE Living with a univentricular heart Heart, July 1, 2001; 86(1): 5 - 6. [Full Text] [PDF]
|
|
|
|
|
|
A Bowling, M Bond, D McKee, M McClay, A P Banning, N Dudley, A Elder, A Martin, and I Blackman Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications Heart, June 1, 2001; 85(6): 680 - 686. [Abstract] [Full Text]
|
|
|
|
|
|
E. Simchen, N. Galai, D. Braun, Y. Zitser-Gurevich, E. Shabtai, and I. Naveh Sociodemographic and clinical factors associated with low quality of life one year after coronary bypass operations: The Israeli Coronary Artery Bypass Study (ISCAB) J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 909 - 919. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Pretre and M. I. Turina Choice of Revascularization Strategy for Patients With Coronary Artery Disease JAMA, February 28, 2001; 285(8): 992 - 994. [Full Text] [PDF]
|
|
|
|
|
|
K. Suehiro, J. Shimizu, G.-H. Yi, S.-M. Zhu, A. Gu, R. R. Sciacca, J. Wang, and D. Burkhoff Direct coronary artery perfusion from the left ventricle J. Thorac. Cardiovasc. Surg., February 1, 2001; 121(2): 0307 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Levy, S Walker, M Mason, P Spurrell, S Rex, S Brant, and V Paul Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study Heart, February 1, 2001; 85(2): 171 - 178. [Abstract] [Full Text]
|
|
|
|
|
|
G M Lindsay, L N Smith, P Hanlon, and D J Wheatley The influence of general health status and social support on symptomatic outcome following coronary artery bypass grafting Heart, January 1, 2001; 85(1): 80 - 86. [Abstract] [Full Text]
|
|
|
|
|
|
S. J. Pocock, R. A. Henderson, T. Clayton, G. H. Lyman, D. A. Chamberlain, and for the RITA-2 Trial Participants Quality of life after coronary angioplasty or continued medical treatment for angina: three-year follow-up in the RITA-2 trial J. Am. Coll. Cardiol., March 15, 2000; 35(4): 907 - 914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
|
|
|
|
|
|
K. L. Yun, C. F. Sintek, A. D. Fletcher, T. A. Pfeffer, G. S. Kochamba, P. R. Mahrer, and S. Khonsari Time related quality of life after elective cardiac operation Ann. Thorac. Surg., October 1, 1999; 68(4): 1314 - 1320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Wahrborg Quality of life after coronary angioplasty or bypass surgery: 1-year follow-up in the Coronary Angioplasty versus Bypass Revascularization Investigation (CABRI) trial Eur. Heart J., May 1, 1999; 20(9): 653 - 658. [Abstract] [PDF]
|
|
|
|
 |
|
 K. M Ninni and L. Brownstein Patient outcome as a selection criterion in determining treatment mode Perfusion, May 1, 1999; 14(3): 213 - 218. [Abstract] [PDF]
|
|
|
|
|
|
T. TREASURE The measurement of health related quality of life Heart, April 1, 1999; 81(4): 331 - 332. [Full Text]
|
|
|
|
|
|
J Herlitz, I Wiklund, K Caidahl, B W Karlson, H Sjöland, M Hartford, M Haglid, and T Karlsson Determinants of an impaired quality of life five years after coronary artery bypass surgery Heart, April 1, 1999; 81(4): 342 - 346. [Abstract] [Full Text]
|
|
|
|
|
|
N Brown, M Melville, D Gray, T Young, J Munro, A M Skene, and J R Hampton Quality of life four years after acute myocardial infarction: short form 36 scores compared with a normal population Heart, April 1, 1999; 81(4): 352 - 358. [Abstract] [Full Text]
|
|
|
|
|
|
T. H. Marwick, C. Zuchowski, M. S. Lauer, M.-A. Secknus, M. J. Williams, and B. W. Lytle Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability J. Am. Coll. Cardiol., March 1, 1999; 33(3): 750 - 758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Cartwright and C. M. Mangano Quality of Life After Coronary Artery Bypass Surgery: Past Progress and Future Directions Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1998; 2(4): 302 - 310. [Abstract] [PDF]
|
|
|
|
|
|
L. I. Bonchek and D. J. Ullyot Minimally Invasive Coronary Bypass : A Dissenting Opinion Circulation, August 11, 1998; 98(6): 495 - 497. [Full Text] [PDF]
|
|
|
|
|
|
The Writing Group for the Bypass Angioplasty Revas Five-Year Clinical and Functional Outcome Comparing Bypass Surgery and Angioplasty in Patients With Multivessel Coronary Disease: A Multicenter Randomized Trial JAMA, March 5, 1997; 277(9): 715 - 721. [Abstract] [PDF]
|
|