Quality of Life after Everolimus-Eluting Stents or Bypass Surgery for Treatment of Left Main Disease after

Background: The EXCEL trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. While rates of death, stroke, and myocardial infarction were similar at 36 months, event timing and repeat revascularization rates differed by treatment group. Objectives: To understand the effects of revascularization strategy from the patient’s perspective, we performed a prospective quality of life (QoL) sub-study alongside the EXCEL trial. Methods: Between September 2010 and March 2014, 1905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1788 participated in the QoL sub-study. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the SF-12, the Rose Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D. Differences between PCI and CABG were assessed using longitudinal random-effect growth curve models. Results: Over 36 months, both PCI and CABG were associated with significant improvements in QoL compared with baseline. At 1 month, PCI was associated with better QoL than CABG. By 12 months though, these differences were largely attenuated, and by 36 months, there were no significant QoL differences between PCI and CABG. Conclusions : Among selected patients with LMCAD, both PCI and CABG result in similar QoL improvement through 36 months, although a greater early benefit is seen with PCI. Taken together with the 3-year clinical results of EXCEL, these findings suggest that PCI and CABG provide similar intermediate-term outcomes for patients with LMCAD. Clinical Trial Information: The EXCEL clinical trial is registered at clinicaltrials.gov ABSTRACT For patients with left main coronary artery disease (LMCAD), the EXCEL trial demonstrated that PCI had similar rates of death, stroke and MI, but higher rates of repeat revascularization, when compared with CABG. We performed a prospective study alongside the EXCEL trial to compare quality of life (QoL) in LMCAD patients treated with PCI or CABG. At 1 month, PCI was associated with better QoL than CABG; however by 3 years, there were no significant QoL differences between the groups. Together with the EXCEL clinical results, these findings suggest that PCI and CABG provide similar intermediate-term outcomes for LMCAD patients. a truncated of the recall and prior a the effects of PCI with a contemporary DES with those of CABG on patient-reported outcomes specifically in LMCAD patients. In this large, multicenter, randomized trial, we found that both PCI and CABG were associated with clinically meaningful and statistically significant improvements in disease-specific and generic health status that were sustained through 36 months. Not surprisingly, PCI resulted in significantly better health status compared with CABG at 1 month (particularly for those domains related to physical function and dyspnea). Nonetheless, there were no significant differences in QoL between the groups at 36 months, and these results were consistent across multiple subgroups.