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Heart Disease

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Cardiac bypass surgery patients have better 1-year outcomes than similar patients who have coronary angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG) are coronary revascularization techniques with similar clinical outcomes, with PTCA gaining favor as first-line treatment for most patients with coronary artery disease. However, 1 year after the procedures, bypass patients have better physical function and quality of life and greater relief from angina than PTCA patients, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11282).

The PTCA-related diminished quality of life and limited functioning were in most cases attributed to the adverse impact of restenosis (a renarrowing or constriction of the affected artery) that affected one-fourth of PTCA patients, explains John A. Spertus, M.D., M.P.H., of Saint Luke's Hospital. He and other Missouri researchers used the Seattle Angina Questionnaire (SAQ) to analyze the health status and functioning of 475 patients (252 who underwent PTCA and 223 who underwent CABG) before the procedure, then monthly for 6 months, and again at 1 year. During PTCA, a catheter is threaded into the blocked artery, and the balloon on its tip is inflated to flatten plaque against the arterial wall to open up the artery.

In-hospital, 6- and 12-month survival rates were not different between the two groups. However, 25 percent of PTCA patients required at least one reintervention (due to reblocking of the affected artery) during the study period, compared with only 1 percent of CABG patients. Although physical function decreased for CABG patients at 1 month, it improved and was better than the PTCA group by 12 months. Relief of angina was greater for CABG than PTCA patients when analyzed over time, principally due to the adverse effects of restenosis in the PTCA group. After 1 year, the quality of life of CABG patients had improved to a greater extent than it had for PTCA patients, even after controlling for differences between the two groups that existed before the procedures.

More details are in "A comparison of the recovery of health status after percutaneous coronary intervention and coronary artery bypass," by A. Michael Borkon, M.D., Gregory F. Muehlebach, M.D., John House, M.S., and others, in the November 2002 Annals of Thoracic Surgery 74, pp. 1526-1530.

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