Quality of Life After Surgery or DES in Patients With 3-Vessel or Left Main Disease

• Published in: Journal of the American College of Cardiology Vol. 69; no. 16; pp. 2039 - 2050
• Main Authors: Abdallah, Mouin S., MD, MSc, Wang, Kaijun, PhD, Magnuson, Elizabeth A., ScD, Osnabrugge, Ruben L., MSc, Kappetein, A. Pieter, MD, PhD, Morice, Marie-Claude, MD, Mohr, Friedrich A., MD, PhD, Serruys, Patrick W., MD, PhD, Cohen, David J., MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 25-04-2017; Elsevier Limited
• Subjects: Aged; Angina; Angina pectoris; Angioplasty; Cardiology; Cardiovascular; Cardiovascular disease; Coronary artery; Coronary Artery Bypass - statistics & numerical data; coronary artery bypass graft; Coronary artery disease; Coronary Artery Disease - surgery; Coronary vessels; Diabetes; Drug delivery; Drug-Eluting Stents; Emotions; Female; Follow-Up Studies; Health; Heart attacks; Heart diseases; Heart surgery; Humans; Implants; Internal Medicine; Intervention; Male; Mental health; Middle Aged; multivessel coronary artery disease; Myocardial infarction; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - statistics & numerical data; Prospective Studies; Quality of Life; Questionnaires; Stents; Surgery; Surgical implants; Syntax; coronary artery disease; SAQ; CAD; Seattle Angina Questionnaire; coronary artery bypass graft; 36-Item Short Form Health Survey; drug-eluting stent(s); QOL; SF-36; Seattle Angina Questionnaire-physical limitations; percutaneous coronary intervention; DES; SAQ-AF; DES-PCI; PCI; Seattle Angina Questionnaire-angina frequency; multivessel coronary artery disease; percutaneous coronary intervention with drug-eluting stent; CABG; quality of life; SAQ-PL
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2017.02.031

Abstract Background In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel or left main coronary artery disease (CAD) had improved long-term outcomes with coronary artery bypass graft (CABG) surgery compared with percutaneous coronary intervention (PCI) with drug-eluting stents (DES), improvements driven mainly by differences in myocardial infarction and repeat revascularization. Objectives This study compared the long-term quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel or left main CAD. Methods Between 2005 and 2007, the SYNTAX trial randomized 1,800 patients with 3-vessel or left main CAD to either CABG or DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and 60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item Short Form Health Survey. Results At 5-year follow-up, CABG was superior to DES-PCI on several SAQ domains including angina frequency and physical function, as well as the role physical and role emotional scales of the 36-Item Short Form Health Survey. Subgroup analysis demonstrated a significant interaction between angiographic complexity (as assessed by the SYNTAX score) and angina relief (mean difference in the SAQ angina frequency score for CABG vs. PCI of −0.9, 3.3, and 3.9 points for low, intermediate, and high SYNTAX score patients, respectively; p = 0.048 for interaction). Conclusions Among patients with 3-vessel or left main CAD, both CABG and DES-PCI were associated with substantial and sustained quality-of-life benefits over 5 years of follow-up. In general, CABG resulted in greater angina relief, although the absolute treatment benefit was small. Angina relief at 5 years was enhanced with CABG among patients with high SYNTAX scores, a finding reinforcing the recommendation that CABG should be strongly preferred for such patients. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972 )