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Functional status after coronary artery bypass grafting and percutaneous transluminal coronary angioplasty
J K Allen1, S T Fitzgerald, R T Swank
1School of Nursing/School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205.
Insights
Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) both improve functional status. CABG showed better long-term psychological functioning and work performance compared to PTCA.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Rehabilitation Medicine
Background:
- Coronary artery disease necessitates interventions like CABG and PTCA.
- Understanding post-procedure recovery and return to work is crucial for patient outcomes.
Purpose of the Study:
- To prospectively compare functional status and return to work in patients undergoing CABG versus PTCA.
- To evaluate changes in daily living, social activity, mental health, and work performance over one year.
Main Methods:
- A prospective study comparing two cohorts: CABG (n=106) and PTCA (n=64).
- Patients were assessed at 1, 6, and 12 months post-procedure using standardized functional status instruments.
- Key outcome measures included activities of daily living, work performance, social activity, and mental health.
Main Results:
- Both CABG and PTCA groups showed significant functional status improvements over one year.
- PTCA patients had greater initial participation in daily and social activities (1 and 6 months), but this advantage diminished by 1 year.
- CABG patients demonstrated superior psychological functioning and greater improvement in work performance among those employed.
Conclusions:
- While both procedures enhance functional status, CABG offers better long-term psychological benefits and work recovery.
- The initial advantages of PTCA in daily activities are not sustained at one year.
- Employment reduction occurred in both groups, irrespective of physical functional improvements.
Abstract:
Two cohorts of consecutive patients of comparable age with similar preprocedure cardiac function who underwent either coronary artery bypass grafting (CABG; n = 106) or percutaneous transluminal coronary angioplasty (PTCA; n = 64) were entered into a prospective comparison study examining functional status and return to work during the first year of recovery. Patients were evaluated using standardized functional status instruments for activities of daily living, work performance, social activity, mental health and quality of social interaction at 1, 6 and 12 months after the procedure. Within the CABG group, statistically significant improvements of functional status on every subscale were noted over the 1-year follow-up. Patients undergoing PTCA demonstrated significant improvement in all dimensions except for the quality of interaction at 1 year as compared with baseline. When the 2 groups were compared, the PTCA group demonstrated greater participation than the CABG group in routine daily physical and social activities at 1 and 6 months, but this apparent advantage disappeared by 1 year. Measures of psychological functioning were better after CABG than after PTCA. A reduction in the number of those with employment occurred in both the CABG and PTCA groups, independent of physical functional status measures, which improved in both groups after the procedures. For those with employment, the CABG group reported the greatest improvement in work performance.