For Multiple Heart Blockages, Bypass Surgery or Stents?
Study Compares Pain, Quality of Life After Drug-Coated Stents or Coronary Artery Bypass Surgery
Before any procedure was performed, an interventional cardiologist and a cardiac surgeon consulted together on each case. If there was mutual agreement that the blocked vessels might be effectively opened using either procedure, the patient was cleared to enter the study.
Before patients were assigned to one procedure or the other, doctors asked patients questions about how often and how strongly they’d been feeling angina, or chest pain, their physical limitations and general quality of life. Based upon the answers, patients were scored on a scale of 1 to 100, with higher scores indicating fewer symptoms and better health status.
Those questions were asked again one month, six months, and 12 months after their procedures.
A disease severity score was also determined at study entry for each patient. This score is dependent upon the degree and extent of blockages as demonstrated on the initial angiogram, with higher scores indicating more complex disease. For subsequent analysis purposes, the patients in the study were divided into three subgroups depending upon their disease severity scores (0 to 22, 23 to 32, and 33 to 83).
In all, 903 patients received stents, while 897 had bypass surgery. In both cases, doctors tried to open all the arteries that were at least 50% blocked.
In the first phase of the study, which was published in 2009, researchers looked primarily at the risk of having a major event, like a heart attack, stroke, or having to reopen an artery that had clogged a second time. After one year, there were about 5% fewer total events in the bypass group compared to the stent group, 12.4% compared to 17.8% respectively.
More patients needed to have clogged arteries reopened in the PCI group than in the CABG group, 13.9% vs. 5.9%, respectively.
After one year, the rate of heart attack or death was similar between the two groups, while stroke was more likely to occur in the bypass group (2.2%) compared to the stent group (0.6%).
Looking at Quality of Life
When researchers looked at angina and quality of life in study participants, overall, both groups fared well. In fact, slightly more than half of people in both groups reported substantial improvement in angina as early as one month after their procedures.
But when investigators looked at those measures across various time points, and in people with more and less severe disease, differences emerged.
As was expected, people who got stents generally felt better faster, compared to the group that had bypass surgery, probably because there was less healing time required after the less invasive procedure.
But by six and 12 months after their procedures, both groups reported nearly equal improvements in physical functioning, pain, vitality, and social and mental health.
And after six months, researchers say people that went into the study with daily or weekly chest pain experienced greater relief after CABG than did those who got PCI.
“Angina relief at six months and a year was better with bypass surgery, though the difference was small,” says Cohen. “But there were clear differences in the early quality of life on a wide range of dimensions that clearly favored PCI, but those benefits were transient,” he says.
The study was sponsored by Boston Scientific, which produces paclitaxel-coated stents.