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Background It has not been clearly established whether percutaneous coronary intervention (PCI) can provide an incremental benefit in quality of life over that provided by optimal medical therapy among patients with chronic coronary artery disease.
Methods We randomly assigned 2287 patients with stable coronary disease to PCI plus optimal medical therapy or to optimal medical therapy alone. We assessed angina-specific health status (with the use of the Seattle Angina Questionnaire) and overall physical and mental function (with the use of the RAND 36-item health survey [RAND-36]).
Results At baseline, 22% of the patients were free of angina. At 3 months, 53% of the patients in the PCI group and 42% in the medical-therapy group were angina-free (P<0.001). Baseline mean (±SD) Seattle Angina Questionnaire scores (which range from 0 to 100, with higher scores indicating better health status) were 66±25 for physical limitations, 54±32 for angina stability, 69±26 for angina frequency, 87±16 for treatment satisfaction, and 51±25 for quality of life. By 3 months, these scores had increased in the PCI group, as compared with the medical-therapy group, to 76±24 versus 72±23 for physical limitation (P=0.004), 77±28 versus 73±27 for angina stability (P=0.002), 85±22 versus 80±23 for angina frequency (P<0.001), 92±12 versus 90±14 for treatment satisfaction (P<0.001), and 73±22 versus 68±23 for quality of life (P<0.001). In general, patients had an incremental benefit from PCI for 6 to 24 months; patients with more severe angina had a greater benefit from PCI. Similar incremental benefits from PCI were seen in some but not all RAND-36 domains. By 36 months, there was no significant difference in health status between the treatment groups.
Conclusions Among patients with stable angina, both those treated with PCI and those treated with optimal medical therapy alone had marked improvements in health status during follow-up. The PCI group had small, but significant, incremental benefits that disappeared by 36 months. (ClinicalTrials.gov number, NCT00007657
[ClinicalTrials.gov]
.)
Source Information
From the Christiana Care Health System, Newark, DE (W.S.W., P.K., C.J., W.Z., J.B.); Mid America Heart Institute/University of Missouri–Kansas City, Kansas City (J.A.S.); Vanderbilt University Medical Center, Nashville (D.J.M.); Emory University, Atlanta (Z.Z., C.L., E.V., S.B.D.); Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT (P.M.H.); Manchester University, Manchester, United Kingdom (C.D.); the Epimetrics Group, San Francisco (S.K.); McMaster University, Hamilton, ON, Canada (R.A.O.); San Antonio Veterans Affairs Medical Center, San Antonio, TX (R.G., K.K.T.); Veterans Affairs Health Economics Resource Center, Palo Alto, CA (P.G.B.); and Western New York Veterans Affairs Healthcare Network and Kaleida Health System, Buffalo (W.E.B.).
Address reprint requests to Dr. Weintraub at the Cardiology Section, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE 19718, or at wweintraub{at}christianacare.org.
Related Letters:
Quality of Life with PCI versus Medical Therapy in Stable Coronary Disease
Beltrame J. F., Tavella R., Cutri N., Rodriguez A. E., Maree A. O., Palacios I. F., Reppel M., Radke P. W., Schunkert H., Kinlay S., Brown R. A., Teirstein P. S., Kandzari D. E., Smith J., Weintraub W. S., Kolm P., Boden W. E., Peterson E. D., Rumsfeld J. S.
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N Engl J Med 2008;
359:2289-2293, Nov 20, 2008.
Correspondence
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