Published Online
on November 22, 2004

A more recent version of this article appeared on November 30, 2004

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Submitted on April 19, 2004
Revised on September 1, 2004
Accepted on September 10, 2004

Neuropsychological Outcome After Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting. Results From the Stent or Surgery (SoS) Trial

Peter Währborg MD, PhD^*, Jean E. Booth BSc, MSc, Tim Clayton BSc, MSc, Fiona Nugara BSc, John Pepper MB, BChir, FRCS, MChir, William S. Weintraub MD, Ulrich Sigwart MD, FESC, FRCP, Rod H. Stables MA, DM, FRCP, for the SoS Neuropsychology Substudy Investigators

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.).

^* To whom correspondence should be addressed. E-mail: peter.wahrborg{at}hjl.gu.se.

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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Fixing the Heart: Must the Brain Pay the Price?

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Circulation 2004 110: 3402-3403. [Extract] [Full Text]

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