In patients with three-vessel or left main coronary artery disease, coronary artery bypass graft surgery provides greater relief from angina at 6 and 12 months after revascularization than does percutaneous coronary intervention with paclitaxel-eluting stents, according to a report in the March 17 issue of the New England Journal of Medicine.
This benefit with CABG was consistent across a broad range of patient characteristics, said Dr. David J. Cohen of Saint Luke’s Mid America Heart Institute, University of Missouri–Kansas City, and his associates in the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial, which was funded by Boston Scientific, maker of the paclitaxel-eluting stent.
SYNTAX was an international randomized trial in which 1,800 patients with three-vessel or left main coronary artery disease underwent either CABG or percutaneous coronary intervention (PCI) with placement of paclitaxel-eluting stents in 2005-2007. The rate of the composite primary efficacy end point of death, myocardial infarction, stroke, or repeat revascularization was found to be lower with CABG at 1 year.
The current analysis was a quality-of-life substudy of SYNTAX aimed at determining whether the two approaches differed with regard to relief from angina and quality of life. It included 903 patients who had been randomly assigned to PCI with stents and 897 who had been assigned to CABG.
At baseline, approximately 12% of the subjects reported having daily angina and 20% reported no angina; the remaining subjects reported occasional angina.
"Both PCI and CABG led to significant improvements in disease-specific and general health status over the course of 12 months," the investigators said.
The primary quality-of-life end point was the score on the Seattle Angina Questionnaire angina frequency subscale. The improvement in this score was slightly but significantly greater with CABG than with PCI at 6 and 12 months.
"There were marked benefits with PCI as compared with CABG in general health-related quality of life as assessed by the SF-36 [Medical Outcomes Study 36-Item Short Form Health Survey] as well as EQ-SD [European Quality of Life 5-Dimensions instrument] at 1 month, but these differences had largely disappeared by 6 months," Dr. Cohen and his colleagues reported (New Engl. J. Med. 2011:364:1016-26).
Subgroup analysis showed that CABG’s superiority in reducing the frequency of angina persisted across a broad range of patients. Subjects who had reported daily or weekly angina at baseline showed significantly better relief after CABG than after PCI, although "the extent of the benefit was small" (76.3% vs. 71.6%, respectively, P = .05).
However, the majority of the study subjects had reported less frequent or no angina at baseline, and there was no significant difference in relief from angina between the two approaches in this large subgroup.
The researchers noted that these findings "reflect only the first year of follow-up after revascularization; whether similar effects are observed over the long term is currently unknown."
Dr. Cohen and his associates reported ties to numerous industry sources, including Boston Scientific.