This Article Full Text Full Text (PDF) All Versions of this Article: 111/6/768    most recent 01.CIR.0000155242.70417.60v1 Alert me when this article is cited Alert me if a correction is posted Citation Map 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 Spertus, J. A. Articles by Rumsfeld, J. S. Search for Related Content PubMed PubMed Citation Articles by Spertus, J. A. Articles by Rumsfeld, J. S. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Coronary Artery Bypass Surgery Related Collections Health policy and outcome research Restenosis Catheter-based coronary interventions: stents CV surgery: coronary artery disease Chronic ischemic heart disease Related Article

(Circulation. 2005;111:768-773.)
© 2005 American Heart Association, Inc.

Health Services and Outcomes Research

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; 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.

Reprint requests to John Spertus, MD, MPH, Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail spertusj{at}umkc.edu

Received May 8, 2004; revision received November 14, 2004; accepted November 19, 2004.

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

Related Article:

Issue Highlights
Circulation 2005 111: 717. [Extract] [Full Text]

This article has been cited by other articles:

				A. M. Davis, L. M. Vinci, T. M. Okwuosa, A. R. Chase, and E. S. Huang Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions Med Care Res Rev, October 1, 2007; 64(5_suppl): 29S - 100S. [Abstract] [PDF]

				Z. Jaffery, M. Kowalski, W. D. Weaver, and S. Khanal A meta-analysis of randomized control trials comparing minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for stenosis of the proximal left anterior descending artery Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 691 - 697. [Abstract] [Full Text] [PDF]

				J. A. Cairns Ranolazine: Augmenting the Antianginal Armamentarium J. Am. Coll. Cardiol., August 1, 2006; 48(3): 576 - 578. [Full Text] [PDF]

				M. Thielmann, R. Leyh, P. Massoudy, M. Neuhauser, I. Aleksic, M. Kamler, U. Herold, J. Piotrowski, and H. Jakob Prognostic Significance of Multiple Previous Percutaneous Coronary Interventions in Patients Undergoing Elective Coronary Artery Bypass Surgery Circulation, July 4, 2006; 114(1_suppl): I-441 - I-447. [Abstract] [Full Text] [PDF]

				H. Thiele, S. Oettel, S. Jacobs, R. Hambrecht, P. Sick, J. F. Gummert, F. W. Mohr, G. Schuler, and V. Falk Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery: A 5-Year Follow-Up Circulation, November 29, 2005; 112(22): 3445 - 3450. [Abstract] [Full Text] [PDF]