PCI and CABG resulted in similar quality of life improvements through 36 months in patients with left main coronary artery disease, with PCI showing greater early benefit at 1 month.
RCT (n=1,788)
Does percutaneous coronary intervention (PCI) using everolimus-eluting stents improve quality of life compared to coronary artery bypass graft (CABG) in patients with unprotected left main coronary artery disease?
In patients with unprotected left main coronary artery disease, PCI provides better early quality of life at 1 month compared to CABG, but both strategies result in similar quality of life improvements by 3 years.
BACKGROUND: The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. Whereas rates of death, stroke, and myocardial infarction were similar at 36 months, event timing and repeat revascularization rates differed by treatment group. OBJECTIVES: To understand the effects of revascularization strategy from the patient's perspective, a prospective quality of life (QoL) substudy was performed alongside the EXCEL trial. METHODS: Between September 2010 and March 2014, 1,905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the 12-Item Short Form Health Survey, the Rose Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D. Differences between PCI and CABG were assessed using longitudinal random-effect growth curve models. RESULTS: Over 36 months, both PCI and CABG were associated with significant improvements in QoL compared with baseline. At 1 month, PCI was associated with better QoL than CABG. By 12 months though, these differences were largely attenuated, and by 36 months, there were no significant QoL differences between PCI and CABG. CONCLUSIONS: Among selected patients with LMCAD, both PCI and CABG result in similar QoL improvement through 36 months, although a greater early benefit is seen with PCI. Taken together with the 3-year clinical results of EXCEL, these findings suggest that PCI and CABG provide similar intermediate-term outcomes for patients with LMCAD. (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization EXCEL; NCT01205776).
Baron et al. (Mon,) conducted a rct in unprotected left main coronary artery disease (LMCAD) (n=1,788). Percutaneous coronary intervention (PCI) using everolimus-eluting stents vs. Coronary artery bypass graft (CABG) was evaluated on Quality of life (QoL) at 36 months. PCI and CABG resulted in similar quality of life improvements through 36 months in patients with left main coronary artery disease, with PCI showing greater early benefit at 1 month.