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Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery.
Circulation 2005; 111(6):768-73Circ

Abstract

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.

Authors+Show Affiliations

Mid America Heart Institute of Saint Luke's Hospital and the University of Missouri, 4401 Wornall Rd, Kansas City, MO 64111, USA. spertusj@umkc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

15699258

Citation

Spertus, John A., et al. "Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery." Circulation, vol. 111, no. 6, 2005, pp. 768-73.
Spertus JA, Nerella R, Kettlekamp R, et al. Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery. Circulation. 2005;111(6):768-73.
Spertus, J. A., Nerella, R., Kettlekamp, R., House, J., Marso, S., Borkon, A. M., & Rumsfeld, J. S. (2005). Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery. Circulation, 111(6), pp. 768-73.
Spertus JA, et al. Risk of Restenosis and Health Status Outcomes for Patients Undergoing Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft Surgery. Circulation. 2005 Feb 15;111(6):768-73. PubMed PMID: 15699258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery. AU - Spertus,John A, AU - Nerella,Ravi, AU - Kettlekamp,Richard, AU - House,John, AU - Marso,Steve, AU - Borkon,A Michael, AU - Rumsfeld,John S, Y1 - 2005/02/07/ PY - 2005/2/9/pubmed PY - 2005/8/10/medline PY - 2005/2/9/entrez SP - 768 EP - 73 JF - Circulation JO - Circulation VL - 111 IS - 6 N2 - 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. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15699258/Risk_of_restenosis_and_health_status_outcomes_for_patients_undergoing_percutaneous_coronary_intervention_versus_coronary_artery_bypass_graft_surgery_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.CIR.0000155242.70417.60?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -