CABG and PCI offer similar improvements in quality of life for diabetics

In patients with diabetes, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents improved health status and quality of life to similar degrees.

Researchers randomized 1,880 diabetic patients (935 CABG, 945 PCI) from 18 countries with multivessel coronary artery disease (CAD) to undergo either CABG surgery or PCI between 2005 and 2010. This prospective substudy of the FREEDOM trial assessed patient health via the Seattle Angina Questionnaire (SAQ) for angina frequency, physical limitations, and quality-of-life scores at baseline, at 1, 6, and 12 months, and then annually. (Scores range from 0 to 100, with higher scores indicating better health.) Results appeared in the Oct. 16 Journal of the American Medical Association.

At 1 month after surgery, PCI patients showed more improvement than CABG patients on the physical limitations score, with a mean difference between CABG and PCI of −8.1 points (95% CI, −9.9 to −6.3 points; P<0.001). PCI patients also showed some greater improvement on the quality-of-life subscale, with a mean difference between CABG and PCI of −1.9 points (95% CI, −3.6 to −0.2 points; P=0.03).

At 6 months, scores for the quality-of-life subscale were similar for the 2 treatment groups, although the physical limitations score modestly favored PCI. At 1 year, patients in the CABG group had better scores on physical limitations (mean difference between CABG and PCI, 2.0 points; 95% CI, 0.4 to 3.6 points; P=0.01) and quality of life (mean difference between CABG and PCI, 1.9 points; 95% CI, 0.4 to 3.4 points; P=0.01).

At 2-year follow-up, there was significantly greater benefit of CABG on each domain (mean treatment benefit, 1.3 points [95% CI, 0.3 to 2.2 points] for angina frequency, 4.4 points [95% CI, 2.7 to 6.1 points] for physical limitations, and 2.2 points [95% CI, 0.7 to 3.8 points] for quality of life; P<0.01 for each comparison). Beyond year 3, there were no consistent between-group differences for the 3 SAQ subscales, although there were significant differences in favor of CABG at 5 years for the physical limitations and quality-of-life subscales.

Researchers noted that the FREEDOM trial has already shown a significant benefit of CABG over PCI for the composite end point of death, myocardial infarction, or stroke among diabetic patients with multivessel CAD, especially patients with the most severe angina at baseline. They also noted that the differences in scores found in this study were small enough that they may not be clinically significant.

The study authors concluded that, based on these results, either treatment provides “substantial and sustained benefits on cardiovascular-specific health status and quality of life” but that previous research shows that CABG should be strongly preferred as the initial revascularization strategy. “[H]owever, some patients who do not wish to face these acute risks [associated with a CABG] may still choose the less invasive PCI strategy. For such patients, our study provides reassurance that there are not major differences in long-term health status and quality of life between the 2 treatment strategies.”