Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery

John A. Spertus, Ravi Nerella, Richard Kettlekamp, John House, Steve Marso, A. Michael Borkon, John S. Rumsfeld

Research output: Contribution to journalArticle

38 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)768-773
Number of pages6
JournalCirculation
Volume111
Issue number6
DOIs
StatePublished - Feb 15 2005

Fingerprint

Percutaneous Coronary Intervention
Coronary Artery Bypass
Health Status
Transplants
Quality of Life
Insurance Benefits
Stents
Linear Models
Metals
Regression Analysis
Surveys and Questionnaires
Survival
Pharmaceutical Preparations

Keywords

  • Angioplasty
  • Bypass
  • Quality of life
  • Restenosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery. / Spertus, John A.; Nerella, Ravi; Kettlekamp, Richard; House, John; Marso, Steve; Borkon, A. Michael; Rumsfeld, John S.

In: Circulation, Vol. 111, No. 6, 15.02.2005, p. 768-773.

Research output: Contribution to journalArticle

Spertus, John A. ; Nerella, Ravi ; Kettlekamp, Richard ; House, John ; Marso, Steve ; Borkon, A. Michael ; Rumsfeld, John S. / Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery. In: Circulation. 2005 ; Vol. 111, No. 6. pp. 768-773.
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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.

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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.

AB - 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.

KW - Angioplasty

KW - Bypass

KW - Quality of life

KW - Restenosis

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