Published Online
on September 15, 2003

A more recent version of this article appeared on October 7, 2003

This Article Full Text (PDF) All Versions of this Article: 108/14/1694    most recent 01.CIR.0000087600.83707.FDv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zhang, Z. Articles by Weintraub, W. S. Search for Related Content PubMed PubMed Citation Articles by Zhang, Z. Articles by Weintraub, W. S. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Coronary Artery Bypass Surgery Coronary Artery Disease Related Collections Catheter-based coronary interventions: stents CV surgery: coronary artery disease

Submitted on December 30, 2002
Revised on June 26, 2003
Accepted on June 26, 2003

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, and 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.

^* To whom correspondence should be addressed. E-mail: wweintr{at}emory.edu.

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

This article has been cited by other articles:

				L. Venkitachalam, K. E. Kip, S. R. Mulukutla, F. Selzer, W. Laskey, J. Slater, H. A. Cohen, R. L. Wilensky, D. O. Williams, O. C. Marroquin, et al. Temporal Trends in Patient-Reported Angina at 1 Year After Percutaneous Coronary Revascularization in the Stent Era: A Report From the National Heart, Lung, and Blood Institute-Sponsored 1997-2006 Dynamic Registry Circ Cardiovasc Qual Outcomes, November 1, 2009; 2(6): 607 - 615. [Abstract] [Full Text] [PDF]

				W. S. Weintraub, J. A. Spertus, P. Kolm, D. J. Maron, Z. Zhang, C. Jurkovitz, W. Zhang, P. M. Hartigan, C. Lewis, E. Veledar, et al. Effect of PCI on Quality of Life in Patients with Stable Coronary Disease N. Engl. J. Med., August 14, 2008; 359(7): 677 - 687. [Abstract] [Full Text] [PDF]

				T. M. Maddox, K. J. Reid, J. A. Spertus, M. Mittleman, H. M. Krumholz, S. Parashar, P. M. Ho, and J. S. Rumsfeld Angina at 1 Year After Myocardial Infarction: Prevalence and Associated Findings Arch Intern Med, June 23, 2008; 168(12): 1310 - 1316. [Abstract] [Full Text] [PDF]

				L. J. Dacey, D. S. Likosky, T. J. Ryan Jr, J. F. Robb, R. D. Quinn, J. T. DeVries, M. J. Hearne, B. J. Leavitt, R. F. Dunton, R. A. Clough, et al. Long-Term Survival After Surgery Versus Percutaneous Intervention in Octogenarians With Multivessel Coronary Disease Ann. Thorac. Surg., December 1, 2007; 84(6): 1904 - 1911. [Abstract] [Full Text] [PDF]

				D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]

				M. Paul, A. Raz, L. Leibovici, H. Madar, R. Holinger, and B. Rubinovitch Sternal wound infection after coronary artery bypass graft surgery: Validation of existing risk scores J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 397 - 403. [Abstract] [Full Text] [PDF]

				M A Denvir, A J Lee, J Rysdale, A Walker, H Eteiba, I R Starkey, and J P Pell Influence of socioeconomic status on clinical outcomes and quality of life after percutaneous coronary intervention. J Epidemiol Community Health, December 1, 2006; 60(12): 1085 - 1088. [Abstract] [Full Text] [PDF]

				W. S. Weintraub and M. K. Banbury Invited commentary. Ann. Thorac. Surg., September 1, 2006; 82(3): 810 - 811. [Full Text] [PDF]

				J. A. Spertus, R. Nerella, R. Kettlekamp, J. House, S. Marso, A. M. Borkon, and J. S. Rumsfeld Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery Circulation, February 15, 2005; 111(6): 768 - 773. [Abstract] [Full Text] [PDF]

				J. Kim, R. A. Henderson, S. J. Pocock, T. Clayton, M. J. Sculpher, K. A.A. Fox, and RITA-3 Trial Investigators Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: One-year results of the third randomized intervention trial of unstable angina (RITA-3) J. Am. Coll. Cardiol., January 18, 2005; 45(2): 221 - 228. [Abstract] [Full Text] [PDF]

				J. A. Spertus, A. C. Salisbury, P. G. Jones, D. G. Conaway, and R. C. Thompson Predictors of Quality-of-Life Benefit After Percutaneous Coronary Intervention Circulation, December 21, 2004; 110(25): 3789 - 3794. [Abstract] [Full Text] [PDF]

				R. Kettelkamp, J. House, M. Garg, R. S. Stuart, A. Grantham, and J. Spertus Using the Risk of Restenosis as a Guide to Triaging Patients Between Surgical and Percutaneous Coronary Revascularization Circulation, September 14, 2004; 110(11_suppl_1): II-50 - II-54. [Abstract] [Full Text] [PDF]

				P. B. Berger, M. H. Sketch Jr, and R. M. Califf Choosing Between Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting for Patients With Multivessel Disease: What Can We Learn From the Arterial Revascularization Therapy Study (ARTS)? Circulation, March 9, 2004; 109(9): 1079 - 1081. [Full Text] [PDF]