CLINICAL RESEARCH
Health-related quality of life after percutaneous coronary intervention versus coronary bypass surgery in high-risk patients with medically refractory ischemia
John S. Rumsfeld, MD, PhD, FACC* ,*,
David J. Magid, MD, MPH ,
Mary E. Plomondon, MSPH*,
Jerome Sacks, PhD ,
William Henderson, PhD,
Mark Hlatky, MD||,
Gulshan Sethi, MD¶,
Douglass A. Morrison, MD, FACC¶ Veterans Affairs Angina With Extremely Serious Operative Mortality (AWESOME) Investigators
* Cardiology and Health Services Research, Denver Veterans Affairs Medical Center, Denver, Colorado, USA
University of Colorado Health Sciences Center, Denver, Colorado, USA
Clinical Research Unit, Colorado Permanente Medical Group, Denver, Colorado, USA
Veterans Affairs Cooperative Studies Program Coordinating Center, Hines Veterans Affairs Medical Center, Hines, Illinois, USA
|| Stanford University, Stanford, California, USA
¶ Tucson Veterans Affairs Medical Center and University of Arizona, Tucson, Arizona, USA
Manuscript received August 9, 2002;
revised manuscript received December 31, 2002,
accepted February 13, 2003.
* Reprint requests and correspondence: Dr. John S. Rumsfeld, Cardiology (111B), Denver Veterans Affairs Medical Center, 1055 Clermont Street, Denver, Colorado 80220, USA.
john.rumsfeld{at}med.va.gov
OBJECTIVES: We compared six-month health-related quality of life (HRQL) for high-risk patients with medically refractory ischemia randomized to percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery.
BACKGROUND: Mortality rates after PCI and CABG surgery are similar. Therefore, differences in HRQL outcomes may help in the selection of a revascularization procedure.
METHODS: Patients were enrolled in a Veterans Affairs multicenter randomized trial comparing PCI versus CABG for patients with medically refractory ischemia and one or more risk factors for adverse outcome; 389 of 423 patients (92%) alive six months after randomization completed an Short Form-36 (SF-36) health status survey. Primary outcomes were the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36. Multivariable analyses were used to evaluate whether PCI or CABG surgery was associated with better PCS or MCS scores after adjusting for over 20 baseline variables.
RESULTS: There were no significant differences in either PCS scores (38.7 vs. 37.3 for PCI and CABG, respectively; p = 0.23) or MCS scores (45.5 vs. 46.1, p = 0.58) between the treatment arms. In multivariable models, there remained no difference in HRQL for post-PCI versus post-CABG patients (for PCS, absolute difference = 0.56 ± standard error of 1.14, p = 0.63; for MCS, absolute difference = –1.23 ± 1.12, p = 0.27). We had 97% power to detect a four-point difference in scores, where four to seven points is a clinically important difference.
CONCLUSIONS: High-risk patients with medically refractory ischemia randomized to PCI versus CABG surgery have equivalent six-month HRQL. Therefore, HRQL concerns should not drive decision-making regarding selection of a revascularization procedure for these patients.
|
Abbreviations and Acronyms
| | AWESOME | | Department of Veterans Affairs Angina With Extremely Serious Operative Mortality study | | BARI | | Bypass Angioplasty Revascularization Investigation trial | | CABG | | coronary artery bypass graft | | CABRI | | Coronary Angioplasty versus Bypass Revascularization Investigation trial | | EAST | | Emory Angioplasty Versus Surgery trial | | HRQL | | health-related quality of life | | IABP | | intra-aortic balloon pump | | MCS | | Mental Component Summary | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | PCS | | Physical Component Summary | | RITA | | Randomized Intervention Treatment of Angina study | | SF-36 | | Short Form-36 | | VA | | Veterans Affairs |
|
This article has been cited by other articles:
|
|
|
|
 
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]
|
|
|
|
|
|
|
R. L. Frye
Update in Cardiology
Ann Intern Med,
August 7, 2007;
147(3):
180 - 186.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Saltzman, M. B. Zimmerman, M. O'Rourke, T. D. Brown, J. A. Buckwalter, and R. Johnston
Impact of Comorbidities on the Measurement of Health in Patients with Ankle Osteoarthritis
J. Bone Joint Surg. Am.,
November 1, 2006;
88(11):
2366 - 2372.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Radford
Percutaneous Coronary Intervention "Dominates" Coronary Artery Bypass Graft Surgery for High-Risk Patients: Good News for Patients, a Challenge for Healthcare Planners
Circulation,
September 19, 2006;
114(12):
1229 - 1231.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. T. Stroupe, D. A. Morrison, M. A. Hlatky, P. G. Barnett, L. Cao, C. Lyttle, D. M. Hynes, W. G. Henderson, and for the Investigators of Veterans Affairs Cooperat
Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients
Circulation,
September 19, 2006;
114(12):
1251 - 1257.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Graham, C. M. Norris, P. D. Galbraith, M. L. Knudtson, W. A. Ghali, and for the APPROACH Investigators
Quality of life after coronary revascularization in the elderly
Eur. Heart J.,
July 2, 2006;
27(14):
1690 - 1698.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. B. Dobbs, R. Nunley, and P. L. Schoenecker
Long-Term Follow-up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release
J. Bone Joint Surg. Am.,
May 1, 2006;
88(5):
986 - 996.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Denollet, S. S. Pedersen, A. T.L. Ong, R. A.M. Erdman, P. W. Serruys, and R. T. van Domburg
Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era
Eur. Heart J.,
January 2, 2006;
27(2):
171 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Szygula-Jurkiewicz, M. Zembala, K. Wilczek, R. Wojnicz, and L. Polonski
Health related quality of life after percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with acute coronary syndromes without ST-segment elevation. 12-month follow up
Eur. J. Cardiothorac. Surg.,
May 1, 2005;
27(5):
882 - 886.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Krumholz
The year in health care delivery and outcomes research
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
1130 - 1136.
[Full Text]
[PDF]
|
|
|
|
