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Quality of Life (QOL) in Diabetics with Multi-Vessel Coronary Artery Disease: Real-World Experience Comparing Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) Open Access


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McGrath, Brent M.
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Introduction Studies demonstrate mortality benefit supporting CABG over PCI in diabetics with multi-vessel CAD. However, CABG is associated with longer recovery and higher stroke rates. Thus, while CABG prolongs life it’s impact on QOL warrants study. This study utilizes comprehensive real-world data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) to compare the baseline, 1, 3 and 5 year QOL of diabetes with multi-vessel CAD by revascularization technique (CABG versus PCI). Methods APPROACH is an outcomes initiative capturing all patients undergoing cardiac revascularization in Alberta since 1995. Health status was measured using the Seattle Angina Questionnaire, a 19-item disease-specific questionnaire measuring five domains of health status: anginal stability, anginal frequency, exertional capacity, QOL and treatment satisfaction. Also captured within APPROACH is detailed information on demographics, comorbidites, first treatment designation (medical, PCI or CABG) and subsequent intervention. The present analysis included diabetics with multi-vessel CAD who had at least 1-year of QOL data. This primary crude analysis compared patient-reported QOL by first revascularization technique (PCI or CABG) among diabetics across baseline, 1, 3 and 5 years. Results At baseline, diabetics undergoing CABG reported worse health status across all domains when compared to PCI(p<0.05). One-year following revascularization, CABG-treated patients reported significantly better levels of angina stability and frequency, treatment satisfaction and QOL(p<0.05) compared to PCI, but did not differ in terms of exertional capacity(p>0.05). At three years, groups differed significantly only in angina stability, favouring CABG-treated patients(p<0.05) with a trend toward better QOL with CABG(p=0.07). There where no significant differences between groups at five years but the trend toward better QOL with CABG persisted(p=0.06). Conclusion Results suggest that diabetics undergoing CABG score significantly worse on health status domains at baseline. Following revascularization they do better than those undergoing PCI with the trend in improved QOL extending out 5-years.
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