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

Abstract

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.