[12-month outcomes of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation in patients with multivessel coronary artery disease].Pol Arch Med Wewn. 2005 Jan; 113(1):56-62.PA
Early invasive strategy is one of two methods of treatment of acute coronary syndromes without ST-segment elevation (NSTEACS). We aimed at assessing 12-month outcomes and quality of life in patients with NSTEACS and multivessel coronary artery disease (CAD) who underwent percutaneous or surgical revascularization. Analyzed group comprised 412 patients (92%) who were qualified for invasive treatment based on coronary angiography performed 24 hours after admission and in whom long-term follow up data was available. The inclusion criteria were: rest angina within 24 hours prior to admission and at least one of the following: ST segment depression (> or = 0.5 mm), transient (< 20 min) ST-segment elevation, negative T-waves (> or = 1 mm)in at least 2 contiguous leads, positive serum cardiac markers. Patients with single-vessel CAD or qualified for conservative treatment were excluded from the study. We analysed the rate of adverse cardiac events (death, non-fatal myocardial infarction, unstable angina, repeated revascularization, cardiovascular hospitalization) at one year. The quality of life was assessed using Short-Form-36 (SF-36) questionnaire. The rate of death was 5.3% vs 9.3% (NS), myocardial infarction 3.4% vs 0% (p = 0.054), unstable angina 20.9% vs 2.8% (p = 0.0000), repeated revascularization 12.6% vs 0% (p = 0.0001) and cardiovascular hospitalization 36% vs 22.7% (p = 0.001) in the PCI and CABG group respectively. Physical Component Summary scores were 38.7 +/- 11.6 vs 43.08 +/- 9.5, p = 0.001 in the PCI and CABG group respectively. Mental Component Summary Scores were similar in both groups (46.34 +/- 13.05 vs 45.97 +/- 11.9, NS).
Overall mortality rate was similar in both groups. PCI patients had more frequent rate of unstable angina, rate of hospitalization and repeat revascularization. This study has shown that there is a significant difference in health-related quality of life 12 months after PCI and CABG. This difference arises from better physical function (Physical Component) for CABG surgery patients compared with PCI patients. Despite impairment of the physical health status, the mental health status (Mental Component) remained similar in both groups.