Document Detail


Do differences in repeat revascularization explain the antianginal benefits of bypass surgery versus percutaneous coronary intervention?: implications for future treatment comparisons.
MedLine Citation:
PMID:  22496114     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with multivessel coronary disease treated with coronary artery bypass graft (CABG) have less angina than those treated with percutaneous coronary intervention (PCI); however, there is uncertainty as to the mechanism of greater angina relief with CABG and whether more frequent repeat revascularization in patients treated with PCI could account for this treatment difference.
METHODS AND RESULTS: In the Synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery trial, 1800 patients with 3-vessel or left main coronary artery disease were randomized to CABG or PCI with paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6, and 12 months, using the Seattle Angina Questionnaire and the Medical Outcomes Study Short Form General Health Survey, and the association between repeat revascularization and health status during follow-up was assessed using longitudinal models. In adjusted analyses, patients who underwent repeat revascularization had worse angina frequency scores than patients who did not in both treatment groups, with differences of 8.5 points at 6 months and 3.1 points at 12 months in patients treated with PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients with patients treated with CABG. Among patients who did not require repeat revascularization, the adjusted effect of CABG versus PCI on 12-month angina frequency scores was nearly identical to the overall benefit in the intention-to-treat analysis.
CONCLUSIONS: Among patients with multivessel coronary artery disease treated with PCI or CABG, the occurrence of repeat revascularization during follow-up did not fully explain the antianginal benefit of CABG in the overall population. The differential association between repeat revascularization and anginal status, according to the type of initial revascularization procedure, suggests that this end point should play a limited role in any direct comparison of the 2 treatment strategies.
Authors:
Suzanne V Arnold; Elizabeth A Magnuson; Kaijun Wang; Patrick W Serruys; A Pieter Kappetein; Friedrich W Mohr; David J Cohen;
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-04-10
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  5     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-17     Completed Date:  2012-09-11     Revised Date:  2012-11-11    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  267-75     Citation Subset:  IM    
Affiliation:
St. Luke's Mid America Heart Institute, Kansas City, MO 64111, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00114972
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina Pectoris / etiology,  surgery,  therapy*
Angioplasty, Balloon, Coronary* / adverse effects,  instrumentation
Cardiovascular Agents / administration & dosage
Chi-Square Distribution
Coronary Artery Bypass* / adverse effects
Coronary Artery Disease / complications,  surgery,  therapy*
Drug-Eluting Stents
Female
Health Status
Humans
Male
Middle Aged
Paclitaxel / administration & dosage
Patient Satisfaction
Prosthesis Design
Quality of Life
Questionnaires
Reoperation
Retreatment
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardiovascular Agents; 33069-62-4/Paclitaxel
Comments/Corrections
Comment In:
Circ Cardiovasc Qual Outcomes. 2012 May;5(3):249-50   [PMID:  22592752 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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