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Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial.
JAMA. 2013 Oct 16; 310(15):1581-90.JAMA

Abstract

IMPORTANCE

The FREEDOM trial demonstrated that among patients with diabetes mellitus and multivessel coronary artery disease, coronary artery bypass graft (CABG) surgery resulted in lower rates of death and myocardial infarction but a higher risk of stroke when compared with percutaneous coronary intervention (PCI) using drug-eluting stents. Whether there are treatment differences in health status, as assessed from the patient's perspective, is unknown.

OBJECTIVES

To compare the relative effects of CABG vs PCI using drug-eluting stents on health status among patients with diabetes mellitus and multivessel coronary artery disease.

DESIGN, SETTING, AND PARTICIPANTS

Between 2005 and 2010, 1900 patients from 18 countries with diabetes mellitus and multivessel coronary artery disease were randomized to undergo either CABG surgery (n = 947) or PCI (n = 953) as an initial treatment strategy. Of these, a total of 1880 patients had baseline health status assessed (935 CABG, 945 PCI) and comprised the primary analytic sample.

INTERVENTIONS

Initial revascularization with CABG surgery or PCI.

MAIN OUTCOMES AND MEASURES

Health status was assessed using the angina frequency, physical limitations, and quality-of-life domains of the Seattle Angina Questionnaire at baseline, at 1, 6, and 12 months, and annually thereafter. For each scale, scores range from 0 to 100 with higher scores representing better health. The effect of CABG surgery vs PCI was evaluated using longitudinal mixed-effect models.

RESULTS

At baseline, mean (SD) scores for the angina frequency, physical limitations, and quality-of-life subscales of the Seattle Angina Questionnaire were 70.9 (25.1), 67.3 (24.4), and 47.8 (25.0) for the CABG group and 71.4 (24.7), 69.9 (23.2), and 49.2 (25.7) for the PCI group, respectively. At 2-year follow-up, mean (SD) scores were 96.0 (11.9), 87.8 (18.7), and 82.2 (18.9) after CABG and 94.7 (14.3), 86.0 (19.3), and 80.4 (19.6) after PCI, with significantly greater benefit of CABG on each domain (mean treatment benefit, 1.3 [95% CI, 0.3-2.2], 4.4 [95% CI, 2.7-6.1], and 2.2 [95% CI, 0.7-3.8] points, respectively; P < .01 for each comparison). Beyond 2 years, the 2 revascularization strategies provided generally similar patient-reported outcomes.

CONCLUSIONS AND RELEVANCE

For patients with diabetes and multivessel CAD, CABG surgery provided slightly better intermediate-term health status and quality of life than PCI using drug-eluting stents. The magnitude of benefit was small, without consistent differences beyond 2 years, in part due to the higher rate of repeat revascularization with PCI.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00086450.

Authors+Show Affiliations

Saint Luke's Mid America Heart Institute, Kansas City, Missouri 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)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24129463

Citation

Abdallah, Mouin S., et al. "Quality of Life After PCI Vs CABG Among Patients With Diabetes and Multivessel Coronary Artery Disease: a Randomized Clinical Trial." JAMA, vol. 310, no. 15, 2013, pp. 1581-90.
Abdallah MS, Wang K, Magnuson EA, et al. Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial. JAMA. 2013;310(15):1581-90.
Abdallah, M. S., Wang, K., Magnuson, E. A., Spertus, J. A., Farkouh, M. E., Fuster, V., & Cohen, D. J. (2013). Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial. JAMA, 310(15), 1581-90. https://doi.org/10.1001/jama.2013.279208
Abdallah MS, et al. Quality of Life After PCI Vs CABG Among Patients With Diabetes and Multivessel Coronary Artery Disease: a Randomized Clinical Trial. JAMA. 2013 Oct 16;310(15):1581-90. PubMed PMID: 24129463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial. AU - Abdallah,Mouin S, AU - Wang,Kaijun, AU - Magnuson,Elizabeth A, AU - Spertus,John A, AU - Farkouh,Michael E, AU - Fuster,Valentin, AU - Cohen,David J, AU - ,, PY - 2013/10/17/entrez PY - 2013/10/17/pubmed PY - 2013/10/30/medline SP - 1581 EP - 90 JF - JAMA JO - JAMA VL - 310 IS - 15 N2 - IMPORTANCE: The FREEDOM trial demonstrated that among patients with diabetes mellitus and multivessel coronary artery disease, coronary artery bypass graft (CABG) surgery resulted in lower rates of death and myocardial infarction but a higher risk of stroke when compared with percutaneous coronary intervention (PCI) using drug-eluting stents. Whether there are treatment differences in health status, as assessed from the patient's perspective, is unknown. OBJECTIVES: To compare the relative effects of CABG vs PCI using drug-eluting stents on health status among patients with diabetes mellitus and multivessel coronary artery disease. DESIGN, SETTING, AND PARTICIPANTS: Between 2005 and 2010, 1900 patients from 18 countries with diabetes mellitus and multivessel coronary artery disease were randomized to undergo either CABG surgery (n = 947) or PCI (n = 953) as an initial treatment strategy. Of these, a total of 1880 patients had baseline health status assessed (935 CABG, 945 PCI) and comprised the primary analytic sample. INTERVENTIONS: Initial revascularization with CABG surgery or PCI. MAIN OUTCOMES AND MEASURES: Health status was assessed using the angina frequency, physical limitations, and quality-of-life domains of the Seattle Angina Questionnaire at baseline, at 1, 6, and 12 months, and annually thereafter. For each scale, scores range from 0 to 100 with higher scores representing better health. The effect of CABG surgery vs PCI was evaluated using longitudinal mixed-effect models. RESULTS: At baseline, mean (SD) scores for the angina frequency, physical limitations, and quality-of-life subscales of the Seattle Angina Questionnaire were 70.9 (25.1), 67.3 (24.4), and 47.8 (25.0) for the CABG group and 71.4 (24.7), 69.9 (23.2), and 49.2 (25.7) for the PCI group, respectively. At 2-year follow-up, mean (SD) scores were 96.0 (11.9), 87.8 (18.7), and 82.2 (18.9) after CABG and 94.7 (14.3), 86.0 (19.3), and 80.4 (19.6) after PCI, with significantly greater benefit of CABG on each domain (mean treatment benefit, 1.3 [95% CI, 0.3-2.2], 4.4 [95% CI, 2.7-6.1], and 2.2 [95% CI, 0.7-3.8] points, respectively; P < .01 for each comparison). Beyond 2 years, the 2 revascularization strategies provided generally similar patient-reported outcomes. CONCLUSIONS AND RELEVANCE: For patients with diabetes and multivessel CAD, CABG surgery provided slightly better intermediate-term health status and quality of life than PCI using drug-eluting stents. The magnitude of benefit was small, without consistent differences beyond 2 years, in part due to the higher rate of repeat revascularization with PCI. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00086450. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/24129463/Quality_of_life_after_PCI_vs_CABG_among_patients_with_diabetes_and_multivessel_coronary_artery_disease:_a_randomized_clinical_trial_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2013.279208 DB - PRIME DP - Unbound Medicine ER -