Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA

Chetan P. Huded; John A. Spertus; Philip G. Jones; Sean M. O'Brien; Daniel B. Mark; Sripal Bangalore; Gregg W. Stone; David O. Williams; Harvey D. White; William E. Boden; Harmony R. Reynolds; Judith S. Hochman; David J. Maron; ISCHEMIA Research Group; Debra K. Johnson; Balram Bhargava

doi:10.1161/CIRCULATIONAHA.125.073591

Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA

Chetan P. Huded, John A. Spertus, Philip G. Jones, Sean M. O'Brien, Daniel B. Mark, Sripal Bangalore, Gregg W. Stone, David O. Williams, Harvey D. White, William E. Boden, Harmony R. Reynolds, Judith S. Hochman, David J. Maron, ISCHEMIA Research Group, Debra K. Johnson, Balram Bhargava

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

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.

Original language	English
Number of pages	13
Journal	Circulation
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.125.073591
Publication status	E-pub ahead of print - 5 Sept 2025

Keywords

coronary artery bypass
coronary disease
health status
myocardial ischemia
percutaneous coronary intervention
quality of life

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/CIRCULATIONAHA.125.073591Licence: In Copyright

Cite this

Huded, C. P., Spertus, J. A., Jones, P. G., O'Brien, S. M., Mark, D. B., Bangalore, S., Stone, G. W., Williams, D. O., White, H. D., Boden, W. E., Reynolds, H. R., Hochman, J. S., Maron, D. J., ISCHEMIA Research Group, Johnson, D. K., & Bhargava, B. (2025). Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA. Circulation. Advance online publication. https://doi.org/10.1161/CIRCULATIONAHA.125.073591

@article{07a54416a5654d1981ba07da390242ab,

title = "Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA",

abstract = "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.",

keywords = "coronary artery bypass, coronary disease, health status, myocardial ischemia, percutaneous coronary intervention, quality of life",

author = "Huded, {Chetan P.} and Spertus, {John A.} and Jones, {Philip G.} and O'Brien, {Sean M.} and Mark, {Daniel B.} and Sripal Bangalore and Stone, {Gregg W.} and Williams, {David O.} and White, {Harvey D.} and Boden, {William E.} and Reynolds, {Harmony R.} and Hochman, {Judith S.} and Maron, {David J.} and {ISCHEMIA Research Group} and Kreton Mavromatis and Jason Linefsky and Todd Miller and Subhash Banerjee and Newman, {Jonathan D.} and Donnino, {Robert M.} and Phillips, {Lawrence M.} and Muhamed Saric and Khaled Abdul-Nour and Stone, {Peter H.} and Jang, {James J.} and Gennie Yee and Steven Weitz and Suzanne Arnold and O'Keefe, {James Henry} and Shapiro, {Michael D.} and Mohammad El-Hajjar and Sidhu, {Mandeep S.} and Fein, {Steven A.} and Stewart, {Wendy L.} and Torosoff, {Mikhail T.} and Salmi, {Kristin M.} and Radmila Lyubarova and Sulagna Mookherjee and Krzysztof Drzymalski and McFalls, {Edward O.} and Garcia, {Santiago A.} and Bertog, {Stefan C.} and Johnson, {Debra K.} and Siddiqui, {Rizwan A.} and Areef Ishani and Hansen, {Ronnell A.} and {Georges Khouri}, Michel and Goldberg, {Jonathan L.} and Richard Goldweit and Cohen, {Ronny A.} and Brooks Mirrer and Victor Navarro and Winchester, {David E.} and Marvin Kronenberg and Christopher McFarren and Heitner, {John F.} and Dauber, {Ira M.} and Charles Cannan and Sriram Sudarshan and Mehta, {Puja K.} and Michael McDaniel and Stamatios Lerakis and Arshed Quyyumi and Wenger, {Nanette K.} and Hedgepeth, {Chester M.} and Heather Hurlburt and Alan Rosen and Zakir Sahul and Steve Leung and Hassan Reda and Khaled Ziada and Sampoornima Setty and Barua, {Rajat S.} and Fadi Hage and Davies, {James E.} and Massoud Leesar and Jaekyeong Heo and Amy Iskandrian and {Al Solaiman}, Firas and Satinder Singh and Khaled Dajani and {Der Mesropian}, Paul and Joseph Sacco and Brian McCandless and Marisa Orgera and Imran Arif and Hanan Kerr and {Trejo Gutierrez}, {Jorge F.} and Gerald Fletcher and Lane, {Gary E.} and Neeson, {Lynn M.} and Parikh, {Pragnesh P.} and Pollak, {Peter M.} and Shapiro, {Brian P.} and Kevin Landolfo and Anthony Gemignani and Daniel O'Rourke and Meadows, {Judith L.} and Call, {Jason T.} and Joseph Hannan and Robert Bojar and Deepti Kumar and John Mukai and Martin, {Edward T.} and Gabriel Vorobiof and Alec Moorman and Scott Kinlay and Hamburger, {Robert J.} and Rocco, {Thomas P.} and Bhatt, {Deepak L.} and Kevin Croce and Quin, {Jacquelyn A.} and Jati Anumpa and Marco Zenati and Faxon, {David P.} and Glenn Rayos and Ashraf Seedhom and Lance Sullenberger and Gregory Kumkumian and Sedlis, {Steven P.} and Donnino, {Robert M.} and Jeffrey Lorin and Tamis-Holland, {Jacqueline E.} and Robert Kornberg and Robert Leber and Souheil Saba and Lee, {Michael W.} and Small, {Delano R.} and Wassim Nona and Alexander, {Patrick B.} and Iram Rehman and Umesh Badami and Kevin Marzo and Robbins, {Inga H.} and Levite, {Howard A.} and Sanjay Shetty and Mayuri Patel and Hamroff, {Glenn S.} and Little, {Raymond W.} and Zimbelman, {Brandi D.} and Lui, {Charles Y.} and Smith, {Brigham R.} and Vezina, {Daniel P.} and Khor, {Lillian L.} and Abraham, {Josephine D.} and Bull, {David A.} and McKellar, {Stephen H.} and David Booth and John Kotter and Ahmed Abdel-Latif and Bob Hu and Labovitz, {Arthur J.} and Michael Berlowitz and Philip Rogal and Fadi Matar and Christiano Caldeira and Fatima Rodriguez and Ingela Schnittger and Fearon, {William F.} and Prakash Deedwania and Kiran Reddy and Joseph Sweeny and Christopher Spizzieri and Hochberg, {Claudia P.} and Salerno, {William D.} and Ray Wyman and Amer Zarka and Shah, {Anil V.} and Thomas Haldis and Kohn, {Jeffrey A.} and Saket Girotra and Omar Almousalli and Krishnam, {Mayil S.} and Milliken, {Jeffrey C.} and Patel, {Pranav M.} and Seto, {Arnold H.} and Harley, {Kevin T.} and Gibson, {Michael A.} and Allen, {Byron J.} and Rita Coram and Sabu Thomas and Schwartz, {Ronald G.} and Wei Chen and {El Shahawy}, Mahfouz and James Stafford and Abernethy, {William B.} and Andrew Zurick and Meyer, {Thomas M.} and Morford, {Ronald G.} and Bruce Rutkin and Sabahat Bokhari and Sokol, {Seth I.} and Jay Meisner and Ihab Hamzeh and Arunima Misra and Matthew Wall and {De Rosen}, {Veronica Lenges} and Mahboob Alam and Turner, {Michael C.} and Mulhearn, {Thomas J.} and Good, {Arnold P.} and Shammas, {Nicolas W.} and Robert Chilton and Nguyen, {Patricia K.} and Matthew Jezior and Gordon, {Paul C.} and Thomas Crain and Robert Stenberg and Pedalino, {Ronald P.} and Joseph Wiesel and Juang, {George J.} and Mohammed Al-Amoodi and David Wohns and Lader, {Ellis W.} and Michael Mumma and Lekshmi Dharmarajan and McGarvey, {Joseph F.X.} and Downes, {Thomas R.} and Luckasen, {Gary J.} and Benjamin Cheong and Srinivasa Potluri and Mastouri, {Ronald A.} and Breall, {Jeffery A.} and Revtyak, {George E.} and Bazeley, {Jonathan W.} and Dayuan Li and Kenneth Giedd and Wayne Old and Francis Burt and Kozhaya Sokhon and Deepika Gopal and Valeti, {Uma S.} and Jon Kobashigawa and {Chakanalil Govindan}, Sajeev and {Gopalan Nair}, Rajesh and {Nanjappa Manjunath}, Cholenahally and Nagaraja Moorthy and {Cholenahally Manjunath}, Satvic and Suryaprakash Narayanappa and Neeraj Pandit and {Kumar Nath}, Ranjit and Dwivedi, {S. K.} and Narain, {V. S.} and Sharad Chandra and Wander, {Gurpreet S.} and Rohit Tandon and Sarju Ralhan and Naved Aslam and Abhishek Goyal and Balram Bhargava and Selvanayagam, {Joseph B.} and Joseph, {Majo X.}",

year = "2025",

month = sep,

day = "5",

doi = "10.1161/CIRCULATIONAHA.125.073591",

language = "English",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams & Wilkins",

}

Huded, CP, Spertus, JA, Jones, PG, O'Brien, SM, Mark, DB, Bangalore, S, Stone, GW, Williams, DO, White, HD, Boden, WE, Reynolds, HR, Hochman, JS, Maron, DJ, ISCHEMIA Research Group, Johnson, DK & Bhargava, B 2025, 'Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA', Circulation. https://doi.org/10.1161/CIRCULATIONAHA.125.073591

TY - JOUR

T1 - Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA

AU - Huded, Chetan P.

AU - Spertus, John A.

AU - Jones, Philip G.

AU - O'Brien, Sean M.

AU - Mark, Daniel B.

AU - Bangalore, Sripal

AU - Stone, Gregg W.

AU - Williams, David O.

AU - White, Harvey D.

AU - Boden, William E.

AU - Reynolds, Harmony R.

AU - Hochman, Judith S.

AU - Maron, David J.

AU - ISCHEMIA Research Group

AU - Mavromatis, Kreton

AU - Linefsky, Jason

AU - Miller, Todd

AU - Banerjee, Subhash

AU - Newman, Jonathan D.

AU - Donnino, Robert M.

AU - Phillips, Lawrence M.

AU - Saric, Muhamed

AU - Abdul-Nour, Khaled

AU - Stone, Peter H.

AU - Jang, James J.

AU - Yee, Gennie

AU - Weitz, Steven

AU - Arnold, Suzanne

AU - O'Keefe, James Henry

AU - Shapiro, Michael D.

AU - El-Hajjar, Mohammad

AU - Sidhu, Mandeep S.

AU - Fein, Steven A.

AU - Stewart, Wendy L.

AU - Torosoff, Mikhail T.

AU - Salmi, Kristin M.

AU - Lyubarova, Radmila

AU - Mookherjee, Sulagna

AU - Drzymalski, Krzysztof

AU - McFalls, Edward O.

AU - Garcia, Santiago A.

AU - Bertog, Stefan C.

AU - Johnson, Debra K.

AU - Siddiqui, Rizwan A.

AU - Ishani, Areef

AU - Hansen, Ronnell A.

AU - Georges Khouri, Michel

AU - Goldberg, Jonathan L.

AU - Goldweit, Richard

AU - Cohen, Ronny A.

AU - Mirrer, Brooks

AU - Navarro, Victor

AU - Winchester, David E.

AU - Kronenberg, Marvin

AU - McFarren, Christopher

AU - Heitner, John F.

AU - Dauber, Ira M.

AU - Cannan, Charles

AU - Sudarshan, Sriram

AU - Mehta, Puja K.

AU - McDaniel, Michael

AU - Lerakis, Stamatios

AU - Quyyumi, Arshed

AU - Wenger, Nanette K.

AU - Hedgepeth, Chester M.

AU - Hurlburt, Heather

AU - Rosen, Alan

AU - Sahul, Zakir

AU - Leung, Steve

AU - Reda, Hassan

AU - Ziada, Khaled

AU - Setty, Sampoornima

AU - Barua, Rajat S.

AU - Hage, Fadi

AU - Davies, James E.

AU - Leesar, Massoud

AU - Heo, Jaekyeong

AU - Iskandrian, Amy

AU - Al Solaiman, Firas

AU - Singh, Satinder

AU - Dajani, Khaled

AU - Der Mesropian, Paul

AU - Sacco, Joseph

AU - McCandless, Brian

AU - Orgera, Marisa

AU - Arif, Imran

AU - Kerr, Hanan

AU - Trejo Gutierrez, Jorge F.

AU - Fletcher, Gerald

AU - Lane, Gary E.

AU - Neeson, Lynn M.

AU - Parikh, Pragnesh P.

AU - Pollak, Peter M.

AU - Shapiro, Brian P.

AU - Landolfo, Kevin

AU - Gemignani, Anthony

AU - O'Rourke, Daniel

AU - Meadows, Judith L.

AU - Call, Jason T.

AU - Hannan, Joseph

AU - Bojar, Robert

AU - Kumar, Deepti

AU - Mukai, John

AU - Martin, Edward T.

AU - Vorobiof, Gabriel

AU - Moorman, Alec

AU - Kinlay, Scott

AU - Hamburger, Robert J.

AU - Rocco, Thomas P.

AU - Bhatt, Deepak L.

AU - Croce, Kevin

AU - Quin, Jacquelyn A.

AU - Anumpa, Jati

AU - Zenati, Marco

AU - Faxon, David P.

AU - Rayos, Glenn

AU - Seedhom, Ashraf

AU - Sullenberger, Lance

AU - Kumkumian, Gregory

AU - Sedlis, Steven P.

AU - Donnino, Robert M.

AU - Lorin, Jeffrey

AU - Tamis-Holland, Jacqueline E.

AU - Kornberg, Robert

AU - Leber, Robert

AU - Saba, Souheil

AU - Lee, Michael W.

AU - Small, Delano R.

AU - Nona, Wassim

AU - Alexander, Patrick B.

AU - Rehman, Iram

AU - Badami, Umesh

AU - Marzo, Kevin

AU - Robbins, Inga H.

AU - Levite, Howard A.

AU - Shetty, Sanjay

AU - Patel, Mayuri

AU - Hamroff, Glenn S.

AU - Little, Raymond W.

AU - Zimbelman, Brandi D.

AU - Lui, Charles Y.

AU - Smith, Brigham R.

AU - Vezina, Daniel P.

AU - Khor, Lillian L.

AU - Abraham, Josephine D.

AU - Bull, David A.

AU - McKellar, Stephen H.

AU - Booth, David

AU - Kotter, John

AU - Abdel-Latif, Ahmed

AU - Hu, Bob

AU - Labovitz, Arthur J.

AU - Berlowitz, Michael

AU - Rogal, Philip

AU - Matar, Fadi

AU - Caldeira, Christiano

AU - Rodriguez, Fatima

AU - Schnittger, Ingela

AU - Fearon, William F.

AU - Deedwania, Prakash

AU - Reddy, Kiran

AU - Sweeny, Joseph

AU - Spizzieri, Christopher

AU - Hochberg, Claudia P.

AU - Salerno, William D.

AU - Wyman, Ray

AU - Zarka, Amer

AU - Shah, Anil V.

AU - Haldis, Thomas

AU - Kohn, Jeffrey A.

AU - Girotra, Saket

AU - Almousalli, Omar

AU - Krishnam, Mayil S.

AU - Milliken, Jeffrey C.

AU - Patel, Pranav M.

AU - Seto, Arnold H.

AU - Harley, Kevin T.

AU - Gibson, Michael A.

AU - Allen, Byron J.

AU - Coram, Rita

AU - Thomas, Sabu

AU - Schwartz, Ronald G.

AU - Chen, Wei

AU - El Shahawy, Mahfouz

AU - Stafford, James

AU - Abernethy, William B.

AU - Zurick, Andrew

AU - Meyer, Thomas M.

AU - Morford, Ronald G.

AU - Rutkin, Bruce

AU - Bokhari, Sabahat

AU - Sokol, Seth I.

AU - Meisner, Jay

AU - Hamzeh, Ihab

AU - Misra, Arunima

AU - Wall, Matthew

AU - De Rosen, Veronica Lenges

AU - Alam, Mahboob

AU - Turner, Michael C.

AU - Mulhearn, Thomas J.

AU - Good, Arnold P.

AU - Shammas, Nicolas W.

AU - Chilton, Robert

AU - Nguyen, Patricia K.

AU - Jezior, Matthew

AU - Gordon, Paul C.

AU - Crain, Thomas

AU - Stenberg, Robert

AU - Pedalino, Ronald P.

AU - Wiesel, Joseph

AU - Juang, George J.

AU - Al-Amoodi, Mohammed

AU - Wohns, David

AU - Lader, Ellis W.

AU - Mumma, Michael

AU - Dharmarajan, Lekshmi

AU - McGarvey, Joseph F.X.

AU - Downes, Thomas R.

AU - Luckasen, Gary J.

AU - Cheong, Benjamin

AU - Potluri, Srinivasa

AU - Mastouri, Ronald A.

AU - Breall, Jeffery A.

AU - Revtyak, George E.

AU - Bazeley, Jonathan W.

AU - Li, Dayuan

AU - Giedd, Kenneth

AU - Old, Wayne

AU - Burt, Francis

AU - Sokhon, Kozhaya

AU - Gopal, Deepika

AU - Valeti, Uma S.

AU - Kobashigawa, Jon

AU - Chakanalil Govindan, Sajeev

AU - Gopalan Nair, Rajesh

AU - Nanjappa Manjunath, Cholenahally

AU - Moorthy, Nagaraja

AU - Cholenahally Manjunath, Satvic

AU - Narayanappa, Suryaprakash

AU - Pandit, Neeraj

AU - Kumar Nath, Ranjit

AU - Dwivedi, S. K.

AU - Narain, V. S.

AU - Chandra, Sharad

AU - Wander, Gurpreet S.

AU - Tandon, Rohit

AU - Ralhan, Sarju

AU - Aslam, Naved

AU - Goyal, Abhishek

AU - Bhargava, Balram

AU - Selvanayagam, Joseph B.

AU - Joseph, Majo X.

PY - 2025/9/5

Y1 - 2025/9/5

N2 - 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.

AB - 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.

KW - coronary artery bypass

KW - coronary disease

KW - health status

KW - myocardial ischemia

KW - percutaneous coronary intervention

KW - quality of life

UR - http://www.scopus.com/inward/record.url?scp=105015434382&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.125.073591

DO - 10.1161/CIRCULATIONAHA.125.073591

M3 - Article

C2 - 40910165

AN - SCOPUS:105015434382

SN - 0009-7322

JO - Circulation

JF - Circulation

ER -

Health Status Outcomes with Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this