Key result
Both PCI and CABG improved 3-year health status versus conservative management; CABG provided better angina relief than PCI at 1 year (OR 1.54; 95% CI 1.03-2.31) but not at 3 years.
Why the study?
Does invasive management with PCI or CABG improve health status outcomes compared to conservative management in patients with chronic coronary disease?
RCT (n=3,770)
Yes
Does invasive management with PCI or CABG improve health status outcomes compared to conservative management in patients with chronic coronary disease?
In patients with chronic coronary disease, both PCI and CABG provide better 3-year health status than conservative management, with CABG offering greater angina relief than PCI at 1 year but not at 3 years.
BACKGROUND: In ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), an invasive strategy demonstrated better health status outcomes than a conservative strategy in patients with chronic coronary disease (CCD). Some previous studies have shown greater health status benefits with coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI). Whether the health status benefits of invasive management in ISCHEMIA were driven primarily by participants treated with CABG is unknown. METHODS: The aim of this analysis was to describe the health status outcomes of participants treated with a conservative strategy (n=2232) compared with invasively managed participants treated with PCI (n=1198) or CABG (n=340) in ISCHEMIA. The Seattle Angina Questionnaire–7 summary score (SAQ-SS) and angina frequency score (SAQ-AF) were the primary outcomes, with higher scores indicating better health status. Proportional odds models comparing 1- and 3-year outcomes were fit, adjusting for demographic, clinical, and angiographic characteristics. RESULTS: SAQ-SS in the conservative, PCI, and CABG groups increased by 9.9±18.1, 15.7±19.3, and 16.1±19.1 points at 1 year and 11.5±20.2, 16.5±21.8, and 15.0±19.4 points at 3 years, respectively. Freedom from angina in the conservative, PCI, and CABG groups was noted in 61.4%, 73.3%, and 82.4% at 1 year and 70.4%, 76.1%, 81.4% at 3 years, respectively. In risk-adjusted analyses, PCI and CABG were each associated with a higher SAQ-SS and SAQ-AF at 1 and 3 years compared with conservative management. SAQ-AF was higher with CABG than PCI at 1 year (odds ratio, 1.54 [95% CI, 1.03, 2.31]), but no differences between CABG and PCI were observed in SAQ-SS (odds ratio, 1.11 [95% CI, 0.78, 1.57]) or SAQ-AF (odds ratio, 0.94 [95% CI, 0.58, 1.54]) at 3 years. CONCLUSIONS: In ISCHEMIA, both PCI and CABG were associated with better 3-year health status than conservative management. Better angina relief with CABG than PCI was seen at 1, but not 3, years. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01471522.
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Huded et al. (2025) conducted an RCT in chronic coronary disease (n=3,770). Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) vs. Conservative strategy was evaluated on Seattle Angina Questionnaire-7 summary score (SAQ-SS) and angina frequency score (SAQ-AF) (OR 1.54, 95% CI 1.03, 2.31). Both PCI and CABG improved 3-year health status versus conservative management; CABG provided better angina relief than PCI at 1 year (OR 1.54; 95% CI 1.03-2.31) but not at 3 years.
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