Evaluating the effect of patient-reported physical and mental health status before PCI/CABG on their long-term outcomes

This study evaluated the effect of patient-reported physical and mental health status before revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) on their long-term outcomes in patients with coronary artery disease (CAD). The data showed that patient-reported physical and mental health status before the procedures was strongly associated with long-term mortality in these patients. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI.

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. This reduces the blood flow to the heart. PCI (or angioplasty) is a non-surgical procedure where narrow or blocked arteries are widened or unblocked. In some cases, a stent is implanted. A stent is a flexible tube that keeps the artery open. Drug-eluting stents (DES) also release medication into the body. These drugs prevent cells from gathering inside the stent and blocking it again.

CABG is a surgical procedure where a healthy blood vessel is taken (usually from the chest wall). This healthy vessel will be connected (‘grafted’) to the blocked artery. This creates a ‘bypass’ around the blocked artery.

The left main coronary artery (LMCA) supplies blood to most of the heart. Usually, the location and severity of the blockage help decide the procedure needed, PCI or CABG. However, whether the patient-reported physical and mental health status before the procedure has any effects on the clinical outcomes after PCI or CABG is still unknown.

This study involved 1656 patients with left main CAD. 841 patients received PCI and 815 patients received CABG. Patients were divided into three groups based on physical component summary (PCS) or mental component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey. A higher PCS score indicated better physical health and a higher MCS score indicated better mental health.

A higher PCS score was associated with a 16% lower risk of death at 10 years. A higher MCS score was associated with a 15% lower risk of death at 10 years.

In patients with the highest PCS (>45.5) and highest MCS (>52.3) scores, treatment with CABG had an overall better survival compared with PCI treatment. The 10-year mortality rate was significantly higher with PCI (30.5%) compared with CABG (12.2%).

In patients with low PCS (≤45.5) or low MCS (≤52.3) scores, there were no significant differences in the 10-year mortality rate between PCI and CABG.

This study concluded that patient-reported physical and mental health status before PCI/CABG procedures was strongly associated with long-term mortality in patients with left main CAD. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI.

This study is based on an outdated technology (first-generation paclitaxel-DES) which may limit the generalizability of these findings to current medical practice which has seen technological improvements in PCI devices.