Quality of life of chronic stable angina patients 4 years after coronary angioplasty or coronary artery bypass surgery

Brorsson B, Bernstein SJ, Brook RH, Werkö L (The Swedish Council on Technology Assessment in Health Care, Stockholm, Sweden; Norrland University Hospital, Umeå, Sweden; Veterans Affairs Health Services Research and Development Field Program, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA; Instituto de Salud Carlos III, Madrid, Spain; University of California, Los Angeles; and RAND Corporation, Santa Monica, CA, USA). Quality of life of chronic stable angina patients 4 years after coronary angioplasty or coronary artery bypass surgery. J Intern Med 2001; 249: 47–57. Objective. To evaluate the quality of life experienced by chronic stable angina patients with one‐ or two‐vessel coronary artery disease treated with percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG). Design. Prospective survey and review of medical records. Patients. Consecutive series of 601 Swedish chronic stable angina patients with one‐ or two‐vessel disease who underwent CABG (n = 252) or PTCA (n = 349) between May 1994 and January 1995. Main outcome measures. We assessed five components of the Swedish Quality of Life Survey, anginal frequency, sublingual nitroglycerin use, and survival at 6, 21 and 48 months following coronary revascularization. Results. Anginal frequency and sublingual nitroglycerin use decreased for all patients by 6 months, but more amongst surgery patients than amongst angioplasty patients (P < 0.05). At 48 months, more bypass patients reported that they had not used sublingual nitroglycerin during the preceding 4 weeks (73.1 vs. 63.4%, P < 0.05). At 6 months, bypass patients had greater levels of improvement in physical functioning (15.3 vs. 10.5, P < 0.05) and general health perception (16.5 vs. 10.2, P < 0.05) than angioplasty patients. Bypass patients also had better relief from pain (19.4 vs. 14.6, P < 0.05), quality of sleep (17.6 vs. 4.6, P < 0.05) and general health perception (17.3 vs. 12.1, P < 0.05) at 21 months. By 48 months follow‐up, there was no longer any difference in these measures between groups. Conclusions. Both bypass surgery and angioplasty lead to improved quality of life for patients with chronic stable angina and one‐ or two‐vessel coronary artery disease. Bypass surgery is associated with better quality of life at 6 months, but by 48 months quality of life is similar for patients initially treated by either procedure.