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Do differences in repeat revascularization explain the antianginal benefits of bypass surgery versus percutaneous coronary intervention?: implications for future treatment comparisons.
Circ Cardiovasc Qual Outcomes 2012; 5(3):267-75CC

Abstract

BACKGROUND

Patients with multivessel coronary disease treated with coronary artery bypass graft (CABG) have less angina than those treated with percutaneous coronary intervention (PCI); however, there is uncertainty as to the mechanism of greater angina relief with CABG and whether more frequent repeat revascularization in patients treated with PCI could account for this treatment difference.

METHODS AND RESULTS

In the Synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery trial, 1800 patients with 3-vessel or left main coronary artery disease were randomized to CABG or PCI with paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6, and 12 months, using the Seattle Angina Questionnaire and the Medical Outcomes Study Short Form General Health Survey, and the association between repeat revascularization and health status during follow-up was assessed using longitudinal models. In adjusted analyses, patients who underwent repeat revascularization had worse angina frequency scores than patients who did not in both treatment groups, with differences of 8.5 points at 6 months and 3.1 points at 12 months in patients treated with PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients with patients treated with CABG. Among patients who did not require repeat revascularization, the adjusted effect of CABG versus PCI on 12-month angina frequency scores was nearly identical to the overall benefit in the intention-to-treat analysis.

CONCLUSIONS

Among patients with multivessel coronary artery disease treated with PCI or CABG, the occurrence of repeat revascularization during follow-up did not fully explain the antianginal benefit of CABG in the overall population. The differential association between repeat revascularization and anginal status, according to the type of initial revascularization procedure, suggests that this end point should play a limited role in any direct comparison of the 2 treatment strategies.

Authors+Show Affiliations

St. Luke's Mid America Heart Institute, Kansas City, MO 64111, USA.No affiliation info availableNo 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
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22496114

Citation

Arnold, Suzanne V., et al. "Do Differences in Repeat Revascularization Explain the Antianginal Benefits of Bypass Surgery Versus Percutaneous Coronary Intervention?: Implications for Future Treatment Comparisons." Circulation. Cardiovascular Quality and Outcomes, vol. 5, no. 3, 2012, pp. 267-75.
Arnold SV, Magnuson EA, Wang K, et al. Do differences in repeat revascularization explain the antianginal benefits of bypass surgery versus percutaneous coronary intervention?: implications for future treatment comparisons. Circ Cardiovasc Qual Outcomes. 2012;5(3):267-75.
Arnold, S. V., Magnuson, E. A., Wang, K., Serruys, P. W., Kappetein, A. P., Mohr, F. W., & Cohen, D. J. (2012). Do differences in repeat revascularization explain the antianginal benefits of bypass surgery versus percutaneous coronary intervention?: implications for future treatment comparisons. Circulation. Cardiovascular Quality and Outcomes, 5(3), pp. 267-75. doi:10.1161/CIRCOUTCOMES.111.964585.
Arnold SV, et al. Do Differences in Repeat Revascularization Explain the Antianginal Benefits of Bypass Surgery Versus Percutaneous Coronary Intervention?: Implications for Future Treatment Comparisons. Circ Cardiovasc Qual Outcomes. 2012;5(3):267-75. PubMed PMID: 22496114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do differences in repeat revascularization explain the antianginal benefits of bypass surgery versus percutaneous coronary intervention?: implications for future treatment comparisons. AU - Arnold,Suzanne V, AU - Magnuson,Elizabeth A, AU - Wang,Kaijun, AU - Serruys,Patrick W, AU - Kappetein,A Pieter, AU - Mohr,Friedrich W, AU - Cohen,David J, AU - ,, Y1 - 2012/04/10/ PY - 2012/4/13/entrez PY - 2012/4/13/pubmed PY - 2012/9/12/medline SP - 267 EP - 75 JF - Circulation. Cardiovascular quality and outcomes JO - Circ Cardiovasc Qual Outcomes VL - 5 IS - 3 N2 - BACKGROUND: Patients with multivessel coronary disease treated with coronary artery bypass graft (CABG) have less angina than those treated with percutaneous coronary intervention (PCI); however, there is uncertainty as to the mechanism of greater angina relief with CABG and whether more frequent repeat revascularization in patients treated with PCI could account for this treatment difference. METHODS AND RESULTS: In the Synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery trial, 1800 patients with 3-vessel or left main coronary artery disease were randomized to CABG or PCI with paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6, and 12 months, using the Seattle Angina Questionnaire and the Medical Outcomes Study Short Form General Health Survey, and the association between repeat revascularization and health status during follow-up was assessed using longitudinal models. In adjusted analyses, patients who underwent repeat revascularization had worse angina frequency scores than patients who did not in both treatment groups, with differences of 8.5 points at 6 months and 3.1 points at 12 months in patients treated with PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients with patients treated with CABG. Among patients who did not require repeat revascularization, the adjusted effect of CABG versus PCI on 12-month angina frequency scores was nearly identical to the overall benefit in the intention-to-treat analysis. CONCLUSIONS: Among patients with multivessel coronary artery disease treated with PCI or CABG, the occurrence of repeat revascularization during follow-up did not fully explain the antianginal benefit of CABG in the overall population. The differential association between repeat revascularization and anginal status, according to the type of initial revascularization procedure, suggests that this end point should play a limited role in any direct comparison of the 2 treatment strategies. SN - 1941-7705 UR - https://www.unboundmedicine.com/medline/citation/22496114/Do_differences_in_repeat_revascularization_explain_the_antianginal_benefits_of_bypass_surgery_versus_percutaneous_coronary_intervention:_implications_for_future_treatment_comparisons_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.111.964585?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -