Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized...

Area of Science:

• Cardiology
• Health Services Research

Background:

• The FREEDOM trial previously showed coronary artery bypass graft (CABG) surgery led to lower death and myocardial infarction rates but higher stroke risk versus percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease.
• Patient-reported health status differences between CABG and PCI in this population were previously unknown.

Purpose of the Study:

• To compare the effects of CABG versus PCI with drug-eluting stents on patient health status.
• To evaluate health status outcomes, including angina frequency, physical limitations, and quality of life, in diabetic patients with multivessel coronary artery disease.

Main Methods:

• The FREEDOM trial randomized 1900 patients with diabetes and multivessel coronary artery disease to either CABG (n=947) or PCI (n=953).
• Health status was assessed using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 6, 12 months, and annually thereafter.
• Longitudinal mixed-effect models were used to evaluate the effect of CABG versus PCI on SAQ domains.

Main Results:

• At baseline, SAQ scores for angina frequency, physical limitations, and quality of life were similar between the CABG and PCI groups.
• At 2-year follow-up, CABG showed significantly greater improvements in all SAQ domains compared to PCI (mean treatment benefit: 1.3 points for angina, 4.4 for limitations, 2.2 for quality of life).
• Beyond 2 years, patient-reported outcomes were generally similar between the two revascularization strategies, partly due to a higher rate of repeat revascularization in the PCI group.

Conclusions:

• For patients with diabetes and multivessel coronary artery disease, CABG surgery provided a small, intermediate-term benefit in health status and quality of life compared to PCI with drug-eluting stents.
• These differences were not consistently observed beyond 2 years.
• The findings suggest that while CABG may offer a slight short-term advantage in patient-reported outcomes, long-term results are comparable, with PCI necessitating more repeat procedures.