Published Online
on February 7, 2005

A more recent version of this article appeared on February 15, 2005

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Submitted on May 8, 2004
Revised on November 14, 2004
Accepted on November 19, 2004

Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery

John A. Spertus MD, MPH^*, Ravi Nerella MD, Richard Kettlekamp MD, John House MS, Steve Marso MD, A. Michael Borkon MD, and John S. Rumsfeld MD, PhD

From the Mid America Heart Institute of Saint Luke’s Hospital and the University of Missouri--Kansas City (J.A.S., R.N., R.K., J.H., S.M., A.M.B.), Kansas City, Mo, and the Denver VA Medical Center (J.S.R.), Denver, Colo.

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

Background--Previous comparisons of percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgery have demonstrated similar survival but have also generally found better health status outcomes (symptoms, function, and quality of life) with CABG. The principal limitation of PCI has been the occurrence of restenosis. No previous studies comparing the health status outcomes of PCI and CABG have examined differences in these outcomes as a function of patients’ preprocedural risk for restenosis.

Methods and Results--We examined the health status outcomes, using the Seattle Angina Questionnaire (SAQ), among 1459 consecutive patients (1027 treated with PCI and 432, with CABG), stratified by their risk for restenosis. In multivariable-adjusted, linear regression analyses, no differences in 1-year angina or quality of life were observed among the 37.4% of patients at low risk for restenosis. However, among the 46.7% at intermediate risk for restenosis, 1-year health status scores were moderately better after CABG surgery compared with PCI (difference in SAQ angina frequency scores favoring CABG=6.1±1.7 points, P=0.0003; difference in SAQ quality of life=5.8±1.6 points, P=0.0004). Even larger differences in 1-year outcomes favoring CABG surgery were observed in patients at high risk for restenosis (SAQ angina frequency difference=10.8±4.2, P=0.01; SAQ quality of life difference=10.8±3.9, P=0.006).

Conclusions--The relative health status benefits of CABG surgery compared with PCI increase as the risk of restenosis increases. Although selecting CABG or PCI is complex, preprocedural restenosis risk should be considered. It should also be tested as a means for considering drug-eluting as opposed to bare metal stents in PCI.

Key words: angioplasty • bypass • restenosis • quality of life

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