Health status outcomes of percutaneous coronary intervention in bypass grafts vs. native coronary arteries
Year: 2016
Type: article
Abstract: Percutaneous coronary intervention (PCI) of bypass grafts is associated with lower technical success and more complications than PCI of native coronary arteries.1,2 However, despite these challenges, no studies have compared patients’ health status (e.g. symptoms, functional status, quality of life) after bypass graft vs. native coronary PCI. Since the primary goal of PCI for stable coronary disease is health status improvement, these data are needed to better understand the whether the benefits of bypass graft intervention are comparable to PCI of native coronary arteries. Patients undergoing PCI at 10 US centres from 2009–11 were prospectively enrolled in the PRISM intervention study.3 Disease-specific health status was assessed with the Seattle Angina Questionnaire (SAQ) before PCI and at 6 and 12 months after PCI.4 For this analysis, we focused on the angina frequency (SAQ-AF), physical limitations (SAQ-PL), and quality of life (SAQ-QL) domains, where scores range from 0 to 100 and higher scores indicate fewer symptoms/limitations. Patients who underwent bypass graft PCI were propensity-matched in a 1:2 fashion to patients with native coronary PCI (non-parsimonious propensity score, balance assessed with standardized differences). Health status recovery after PCI was compared between groups using repeated measures analysis of co-variance, adjusting for clinically relevant variables including: baseline health status scores, age, sex, race, body mass index, insurance status, smoking history, history of prior MI, history of prior PCI, history of cerebrovascular disease, history of heart failure, dyslipidaemia, atrial fibrillation, history of peripheral arterial disease, hypertension, diabetes, creatinine, history of dialysis, depression, haemoglobin, chronic lung disease, type of MI, number of anti-anginal medications, and completeness of revascularization. Missing data (< 5% for any single variable, assumed to be missing at random) were imputed with a single imputation using IVEWARE.5 Sensitivity analyses were conducted using inverse probability weighting (IPW) to test the effect of missing follow-up scores on overall results. Of 3267 PCI patients, 207 (6.3%) underwent bypass graft PCI (89% saphenous venous graft PCI) with the remaining undergoing only native coronary PCI. PCI was performed for stable CAD in 34%, unstable angina in 34%, NSTEMI in 20%, and other indications in 12%. Compared with patients undergoing native coronary PCI, patients who underwent bypass graft PCI were significantly older, more likely male, and had more comorbidities (e.g. prior MI, heart failure, atrial fibrillation, peripheral artery disease, diabetes). Prior to PCI, patients with bypass graft PCI had worse health status and were taking more anti-anginal medications. Health status outcomes in PCI to bypass graft versus native coronary artery. Analysis (point estimate ± CIs) on overall and on propensity matched cohort. Health status outcomes in PCI to bypass graft versus native coronary artery. These data suggest that patients who require bypass graft PCI are older, generally in poorer health and have more angina at baseline but, after taking into account these baseline differences, bypass graft PCI was associated with similar improvement in symptoms, functional status, and quality of life as native coronary PCI. Despite prior literature suggesting that bypass graft PCI is associated with more complications and less technical success, we found similar long-term health status benefits. The comparability of health status benefits in bypass and native coronary PCI should be interpreted in the context of the following potential limitations. As an observational study, there may be unmeasured confounding that could not be addressed even with successful propensity-matching. Second, we only examined health status recovery through 12 months. As graft PCI may be associated with greater long-term restenosis rates, differences in health status may emerge after 12 months. Finally, no core lab review of angiograms to quantify the success of PCI was performed, precluding more detailed analyses of the association between angiographic and technical results with health status outcomes. In conclusion, although patients with graft PCI were generally sicker and had worse health status prior to PCI, after accounting for such differences, we found that patients with graft PCI had similarly good health status recovery after PCI as compared with patients undergoing PCI of a native coronary artery. Although technical considerations may influence an operator’s decision to perform PCI in a bypass graft, concerns about the potential health status benefits should not preclude intervention. The Outcomes of PCI Study (OPS) was supported by an American Heart Association Outcomes Research Center grant (0875149N), and the Personalized Risk Information Services ManagerTM (PRISM) study was supported by a grant from the National Heart Lung and Blood Institute (R01-HL096624). M.Q. is supported by The National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL110837. All data collection, data analyses, the preparation of the manuscript, and the decision to submit the manuscript for publication were independent from input of the study sponsor.
Institutions: Saint Luke's Hospital, University of Missouri–Kansas City
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2532738112