Short- and long- term health related quality-of-life and anginal status after randomisation to coronary stenting versus bypass surgery for the treatment of multivessel disease: results of the Arterial Revascularisation Therapy Study (ARTS)

Abstract

Health related quality-of-life (HRQL) beyond one year of treatment of multivessel coronary artery disease with stenting or coronary artery bypass grafting (CABG) is yet unknown. The Arterial Revascularisation Therapy Study (ARTS) was designed to compare CABG and stenting in multivessel disease. HRQL was evaluated at baseline, at 1- month and at 6-, 12- and 36 months after revascularisation using the Short Form Health Survey (SF-36) in patients randomised to stenting (n=483) versus CABG (n=492). Both stenting and CABG resulted in significant improvement of HRQL and anginal status. Although there was a trend for better HRQL after CABG up to one year, the disparity between the two procedures decreased long-term. Most of the difference between the two procedures was attributed to repeat interventions in the stent group; at three years, 19% of stent patients versus 13% of CABG patients (p<0.0001) had undergone a repeat intervention. On most of the SF-36 scores, there was no difference between diabetics and non-diabetics, with diabetic patients having a worse score only on general health and physical functioning at all time points (p<0.0001). Both stenting and CABG resulted in a significant improvement in HRQL especially up to one year, but CABG was associated with less angina at all time points. There was a trend for better HRQL after CABG, but this difference was mainly attributed to repeat revascularisation in the stent group. Based on these findings, patients should select for themselves whether or not they would prefer the improved HRQL benefits after CABG, or whether they would prefer more angina after PCI and avoid a major operation.