Quality of life after coronary angioplasty or bypass surgery: 1-Year follow-up in the coronary angioplasty versus bypass revascularization investigation (CABRI) trial

Abstract

Background. Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) have both been shown to be safe and effective in the treatment of coronary artery disease. Nine randomized studies comparing CABG and PTCA have delivered consistent results, with no significant differences in mortality between the methods, either in single or in multivessel coronary artery disease. An important outcome measurement after intervention is the patient's subjective appraisal of the intervention. Results from the CABRI substudy on quality of life at 1 year follow-up are presented in this report. Methods. CABRI is a multicentre, randomized, open comparison of patients assigned to either PTCA or CABG. Patients were recruited from 26 high volume European hospitals over a 53 month period starting in July 1988. A quality of life substudy was also set up, but participation was optional. Seven out of 26 centres took part in the study. One hundred and fifty-four (14.6%) out of the 1054 main study patients participated. Perceived health status was assessed at baseline and 1 year after revascularization by means of The Nottingham Health Profile and a set of 12 other questions. Results. A significant improvement in quality of life in terms of the total score and in the Nottingham Health Profile for both groups, as compared with baseline, was found. A trend towards better outcome concerning energy was found favouring CABG. This trend might be due to the fact that the CABRI protocol permitted incomplete revascularization in the PTCA arm and did not exclude patients with totally occluded vessels. When adjusted for baseline differences, no difference in health-related quality of life at follow-up was found between the sexes, or between the PTCA and the CABG groups. A significant correlation was found between improvement in quality of life and severity of angina when adjusted for baseline values. Conclusions. This study has shown that there is no general difference in health-related quality of life 1 year after bypass surgery or angioplasty; however, data presented are suggestive of a more favourable outcome in degree of perceived energy in the bypass group.