Quality of Life after PCI with Drug-Eluting Stents or Coronary-Artery Bypass Surgery — NEJM

Original Article

Quality of Life after PCI with Drug-Eluting Stents or Coronary-Artery Bypass Surgery
David J. Cohen, M.D., Ben Van Hout, Ph.D., Patrick W. Serruys, M.D., Ph.D., Friedrich W. Mohr, M.D., Ph.D., Carlos Macaya, M.D., Peter den Heijer, M.D., Ph.D., M.M. Vrakking, M.D., Kaijun Wang, Ph.D., Elizabeth M. Mahoney, Sc.D., Salma Audi, M.Sc., Katrin Leadley, M.D., Keith D. Dawkins, M.D., and A. Pieter Kappetein, M.D., Ph.D. for the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Investigators

N Engl J Med 2011; 364:1016-1026March 17, 2011

Abstract
Background
Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in greater relief from angina and improved quality of life. The effect of PCI with the use of drug-eluting stents on these outcomes is unknown.


Methods
In a large, randomized trial, we assigned 1800 patients with three-vessel or left main coronary artery disease to undergo either CABG (897 patients) or PCI with paclitaxel-eluting stents (903 patients). Health-related quality of life was assessed at baseline and at 1, 6, and 12 months with the use of the Seattle Angina Questionnaire (SAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The primary end point was the score on the angina-frequency subscale of the SAQ (on which scores range from 0 to 100, with higher scores indicating better health status).


Results
The scores on each of the SAQ and SF-36 subscales were significantly higher at 6 and 12 months than at baseline in both groups. The score on the angina-frequency subscale of the SAQ increased to a greater extent with CABG than with PCI at both 6 and 12 months (P=0.04 and P=0.03, respectively), but the between-group differences were small (mean treatment effect of 1.7 points at both time points). The proportion of patients who were free from angina was similar in the two groups at 1 month and 6 months and was higher in the CABG group than in the PCI group at 12 months (76.3% vs. 71.6%, P=0.05). Scores on all the other SAQ and SF-36 subscales were either higher in the PCI group (mainly at 1 month) or were similar in the two groups throughout the follow-up period.


Conclusions
Among patients with three-vessel or left main coronary artery disease, there was greater relief from angina after CABG than after PCI at 6 and 12 months, although the extent of the benefit was small. (Funded by Boston Scientific; ClinicalTrials.gov number, NCT00114972.)



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Quality of Life after PCI with Drug-Eluting Stents or Coronary-Artery Bypass Surgery — NEJM