Quality of Life After Surgery or DES in Patients With 3-Vessel or Left Main Disease
Open accessAbstract
Background In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel or left main coronary artery disease (CAD) had improved long-term outcomes with coronary artery bypass graft (CABG) surgery compared with percutaneous coronary intervention (PCI) with drug-eluting stents (DES), improvements driven mainly by differences in myocardial infarction and repeat revascularization.Objectives This study compared the long-term quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel or left main CAD.Methods Between 2005 and 2007, the SYNTAX trial randomized 1,800 patients with 3-vessel or left main CAD to either CABG or DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and 60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item Short Form Health Survey.Results At 5-year follow-up, CABG was superior to DES-PCI on several SAQ domains including angina frequency and physical function, as well as the role physical and role emotional scales of the 36-Item Short Form Health Survey. Subgroup analysis demonstrated a significant interaction between angiographic complexity (as assessed by the SYNTAX score) and angina relief (mean difference in the SAQ angina frequency score for CABG vs. PCI of -0.9, 3.3, and 3.9 points for low, intermediate, and high SYNTAX score patients, respectively; p = 0.048 for interaction).Conclusions Among patients with 3-vessel or left main CAD, both CABG and DES-PCI were associated with substantial and sustained quality-of-life benefits over 5 years of follow-up. In general, CABG resulted in greater angina relief, although the absolute treatment benefit was small. Angina relief at 5 years was enhanced with CABG among patients with high SYNTAX scores, a finding reinforcing the recommendation that CABG should be strongly preferred for such patients. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972).
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Residual angina after revascularization is common, with approximately 20% to 30% of patients reporting angina at 1 year after revascularization.
“residual angina after revascularization is quite common, with ≈20% to 30% of patients reporting angina at 1 year after revascularization”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [243]
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- Authors
- Abdallah, M. S., Wang, K., Magnuson, E. A., Osnabrugge, R. L., Kappetein, A. P., Morice, M.-C., Mohr, F. A., Serruys, P. W., & Cohen, D. J.
- Affiliations
- Cleveland Clinic (US)
- Saint Luke's Hospital (US)
- Erasmus MC (NL)
- Hôpital Privé Jacques Cartier (FR)
- Corresponding author
- Cohen, David J.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 69
- Issue
- 16
- Pages
- 2039-2050
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2607400219
- Cited by
- 82
- References
- 31
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 3 · 2023: 10 · 2022: 10 · 2021: 13 · 2020: 8 · 2019: 7 · 2018: 11 · 2017: 7
- FWCI
- 9.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Eli Lilly and Company
- AstraZeneca
- Edwards Lifesciences
- Boston Scientific Corporation
- Cardinal Health
- Saint Luke's Health System
- Daiichi-Sankyo
- Abbott Vascular
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- quality of life, coronary artery bypass grafting, percutaneous coronary intervention, drug-eluting stents, three-vessel coronary artery disease, left main coronary artery disease, SYNTAX score, angina relief, Seattle Angina Questionnaire, SF-36, SYNTAX trial, revascularization
- MeSH terms
- Aged, Coronary Artery Bypass, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Drug-Eluting Stents, Percutaneous Coronary Intervention
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