High-risk heart disease patients randomized to angioplasty or bypass surgery are not only equally likely to be alive 6 months later, but their physical and mental quality of life is virtually identical, according to an article in the May 21st issue of the Journal of the American College of Cardiology.

"I think this finding is quite surprising to clinicians, because they had such strong feelings about which way this would go. It just shows the importance of studying this in a careful manner," said John S. Rumsfeld, MD, PhD, FACC, a study coauthor.

The American researchers surveyed 389 people, representing 92 percent of the patients alive 6 months after treatment in the Angina With Extremely Serious Operative Mortality (AWESOME) study. Researchers had previously reported equivalent survival outcomes for these high-risk patients, who had been randomized to either angioplasty or bypass surgery. Patients like the ones in this study, who have multivessel coronary disease that cannot be managed with drug therapy, usually have been excluded from major studies because of their age (most were older than 70 years), prior bypass surgery, or severe heart failure. However, Rumsfeld noted that older, sicker patients like these are a growing part of the population.

Patients reported information with use of the Physical Component Summary or the Mental Component Summary of an established health status survey known as the Short Form-36. Multivariable statistical analysis confirmed there were no significant differences in health-related quality of life outcomes for the two groups of patients. Rumsfeld said the fact that patients were randomized to treatment and an established survey form was used for postoperative assessment gave the researchers greater confidence in these results compared with results from observational studies.

Rumsfeld noted that the findings of equivalent outcomes may clash with the opinions of many clinicians who may have favored one course of treatment over the other. "The study tells us that angioplasty and bypass surgery, done on high-risk patients with multivessel coronary disease, leads to equivalent quality of life outcomes. Therefore, I don't think that concerns about quality of life outcomes you may have about one or the other treatment should be the reason for choosing a revascularization strategy."

He suggested that factors such as a patient's specific coronary anatomy will play a major role in choosing between procedures. However, in many instances both treatments will be viable options, and the study results suggest that in these cases clinicians can best serve patients by letting the patients' personal preferences guide the selection process.

He noted, however, that equivalent outcomes do not mean that angioplasty and bypass surgery are identical. "You get to the same outcome, as far as the patient's overall physical and mental health status. How you get there, though, is going to be quite different. These differences in experiences may help different patients choose which one they want. Some patients will say, 'I'll take the risk of going through the major operation with a coronary bypass, so that I have a more durable time afterwards without chest pain or having to come back for more procedures.' Other patients will look at angioplasty and say, 'I'd rather do this and not be put under anesthesia, undergo the cardiopulmonary bypass and have such a major operation, but I understand that I'm much more likely to have recurrent chest pain and have to come back in for more angioplasty.'"