Quality of life following coronary artery bypass graft surgery vs. percutaneous coronary intervention in diabetics with multivessel disease: a five-year registry study

Aims: The aim of this study is to investigate the long-term relationship between revascularization technique and health status in diabetics with multivessel disease. Methods and results: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, we captured 1319 diabetics with multivessel disease requiring revascularization for an acute coronary syndrome (January 2009-December 2012) and reported health status using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 3 and 5-years 599 underwent coronary artery bypass grafting (CABG); 720 underwent percutaneous coronary intervention (PCI). Adjusted analyses were performed using a propensity score-matching technique. After adjustment (including baseline SAQ domain scores), 1-year mean (95% CI) SAQ scores (range 0-100 with higher scores reflecting improved health status) were significantly greater in selected domains for CABG compared to PCI (exertional capacity: 81.7 79.5-84.0 vs. 78.8 76.5-81.0, P = 0.07; angina stability: 83.1 80.4-85.9 vs. 75.0 72.3-77.8, P < 0.001]; angina frequency 93.2 91.6-95.0 vs. 90.0 87.8-91.3, P = 0.003; treatment satisfaction: 93.6 92.2-94.9 vs. 90.8 89.2-92.0, P = 0.003; quality of life QOL: 83.8 81.7-85.8 vs. 77.2 75.2-79.2 P < 0.001). At 3-years, these benefits were attenuated (exertional capacity: 79.3 76.9-81.7 vs. 78.7 76.3-81.1, P = 0.734; angina stability 79.3 76.3-82.3 vs. 75.5 72.5-78.5, P = 0.080; angina frequency: 93.2 91.3-95.1 vs. 90.9 89.0-92.8, P = 0.095; treatment satisfaction: 92.5 91.0-94.0 vs. 91.5 90.0-93.0 P = 0.382; QOL: 83.2 81.1-85.2 vs. 80.3 78.2-82.4, P = 0.057). At 5-years, majority of domains were similar (exertional capacity: 77.8 75.0-80.6 vs. 76.3 73.2-79.3, P = 0.482; angina stability: 78.0 74.8-81.2 vs. 74.8 71.4-78.2, P = 0.175; angina frequency: 94.2 92.3-96.0 vs. 90.9 89.0-92.9, P = 0.018; treatment satisfaction: 93.7 92.2-95.1 vs. 92.2 90.6-93.7, P = 0.167; QOL: 84.1 82.0-86.3 vs. 81.1 78.8-83.4, P = 0.058). Majority in both groups remained angina-free at 5-years (75.0% vs. 70.3%, P = 0.15). Conclusion: Improvements in health status with CABG compared with PCI were not sustained long-term. This temporal sequence should be considered when contemplating a revascularization strategy in diabetics with multivessel disease.