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Quality Of Life Better With Both CABG And PCI

Wed, 10/16/2013 - 9:31am
Todd Neale

Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents resulted in dramatic improvements in quality of life among diabetic patients with multivessel disease, a subanalysis of the FREEDOM trial showed.

Although improvements were more rapid in the PCI group, and slightly better through the first 2 years in the CABG group, health status was mostly similar in the two groups in the long term, David Cohen, MD, of Saint Luke's Mid American Heart Institute in Kansas City, Mo., and colleagues reported in the Oct. 16 issue of the Journal of the American Medical Association.

The small differences in quality of life contrasted with the substantial difference in the 5-year rate of death, stroke, or myocardial infarction (MI) seen in the main trial results -- 26.6% with PCI versus 18.7% with CABG (P=0.005). CABG lowered the rates of death and MI, but increased the rate of stroke.

The quality-of-life differences were smaller than expected because many patients who were treated initially with PCI required a repeat revascularization procedure (12.6% versus 4.8% in the CABG group through 1 year) and many underwent CABG for the second procedure, according to co-author Valentin Fuster, MD, PhD, of Mount Sinai Medical Center in New York City, who led the FREEDOM trial.

Fuster told MedPage Today that the main message from FREEDOM remains clear: "There are always exceptions, but the exception should not overcome the reality of this trial, and that is that about 25% of patients that today we see in the cardiac catheterization laboratory have multivessel disease with diabetes and they should be considered after the angiogram for bypass surgery, not for PCI."

In their paper, Cohen, Fuster, and colleagues pointed out that there still might be a role for PCI for some patients.

"Given the increased rate of stroke, as well as the well-recognized longer recovery period with CABG surgery, ... some patients who do not wish to face these acute risks may still choose the less invasive PCI strategy," they wrote. "For such patients, our study provides reassurance that there are not major differences in long-term health status and quality of life between the two treatment strategies."

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