Quality-of-life outcomes better with CABG vs. PCI in three-vessel, left main CAD
Patients who underwent CABG vs. PCI with a drug-eluting stent had improved angina frequency, physical function, and physical and emotional scores on quality-of-life assessments at 5 years, according to data from the SYNTAX trial.
In SYNTAX, researchers found that CABG yielded greater improvements in long-term clinical outcomes, such as a composite endpoint of death, MI, stroke or repeat revascularization, compared with PCI with a first-generation paclitaxel-eluting stent (Taxus Express, Boston Scientific) in patients with three-vessel or left main CAD. The benefit, they noted, was primarily driven by decreased rates of repeat revascularization and MI.
To assess long-term quality of life, the researchers evaluated health status of the 1,800 patients randomly assigned to CABG or PCI at baseline, 1, 6, 12, 36 and 60 months using the Seattle Angina Questionnaire (SAQ) and the 36-Item Short Form Health Survey (SF-36).
“It’s important to look at quality of life in addition to clinical outcomes. Many times, cardiologists focus on MACCE, but from a patient perspective, how they feel going through the process, how functional they are and whether they are experiencing physical or angina pain or cardiac symptoms are also important,” study researcher Mouin S. Abdallah, MD, MSc, cardiologist at Cleveland Clinic, told Cardiology Today’s Intervention.
Both CABG and PCI were associated with improvements in cardiac-specific and general health status. Patients who underwent PCI experienced more rapid improvement in health status than those who underwent CABG, but at 5 years, angina frequency and physical function as measured by the SAQ favored CABG over PCI (mean differences, 2.1 and 3 points, respectively; P < .05 for both).
Similarly, at 1 month, patients who underwent PCI experienced greater improvements on the role physical and role emotional scales and the mental health component summary scale of the SF-36, but at 5 years, CABG was associated with higher scores compared with PCI (mean differences, 3.1, 4 and 1.5 points, respectively; P < .05 for all).
Additionally, subgroup analysis showed that angina relief was related to angiographic complexity. The mean difference in SAQ-angina frequency score for CABG vs. PCI was –0.9 points for patients with low SYNTAX scores, 3.3 points for patients with intermediate SYNTAX scores and 3.9 points for patients with high SYNTAX scores (P for interaction = .048).
“The study results reinforce the guidelines, which recommend that patients with complex multivessel disease as defined by SYNTAX score should definitely undergo bypass as a first-line treatment,” Abdallah said in an interview. “What is interesting is that patients with a low SYNTAX score might have the same outcomes as they undergo bypass or PCI. This means many patients might have a choice. They should therefore be evaluated by both the surgeon and interventional cardiologist and have a discussion about not only the risk for complications, such as mortality, stroke or future revascularization, but also the quality-of-life outcomes after the procedure. Then patients should have an input regarding treatment choice. Not every patient with multivessel disease should be rushed to surgery.” – by Melissa Foster
Disclosure: The study was funded by Boston Scientific. Abdallah reports no relevant financial disclosures. Please see the full study for a list of the researchers’ relevant financial disclosures.