Abstract 13201: 5-Year Quality of Life Outcomes After CABG vs. PCI among Patients With 3-Vessel or Left Main Coronary Disease: Results From the SYNTAX Trial
Background: Among patients with 3-vessel or left main CAD, CABG results in greater angina relief at 1 year than PCI with drug-eluting stents (DES-PCI). Whether these benefits are sustained beyond 1 year is unknown.
Methods: Between 2005 and 2007, the SYNTAX trial randomized 1800 patients with left main or 3-vessel CAD to revascularization with either CABG (n=897) or DES-PCI (n=903). Health status was assessed at baseline, 1, 6, 12, 36 and 60 months using both the Seattle Angina Questionnaire (SAQ) and the SF-36 health survey.
Results: At baseline, the study population had significant health status limitations including daily angina in 11.6%, weekly angina in 27.9%, and monthly angina in 38.4%. Although angina relief and cardiac-specific quality of life were slightly better with CABG at 1-year, by 3-year follow-up, these differences were no longer apparent (see Table). At 5-year follow-up, however, patients undergoing initial CABG reported small but significant benefits compared with DES-PCI on several SAQ domains including angina frequency and physical function as well as the role physical and role emotional scales of the SF-36. Subgroup analysis demonstrated a significant interaction between SYNTAX score and angina relief (mean treatment difference for CABG vs. PCI of -0.9, 3.3, and 3.9 points for low, intermediate, and high SYNTAX score patients, respectively; p=0.048 for interaction).
Conclusion: Among patients with 3-vessel or left main CAD, both CABG and DES-PCI resulted in substantial and sustained QOL benefits over 5-years of follow-up. In general, CABG resulted in greater angina relief over time, although the absolute treatment benefit was relatively small. Similar to the clinical results, angina relief at 5-years was enhanced with CABG among patients with high SYNTAX scores, reinforcing the recommendation that CABG should be strongly preferred for such patients.
- Percutaneous coronary intervention
- Cardiac surgery
- Quality of life
- Clinical trials
- Coronary artery disease
- © 2013 by American Heart Association, Inc.