Bypass surgery is superior to stent-assisted angioplasty in relief of angina and improvement in quality of life in the year after the procedure, according to an article in the September 16th rapid access issue of Circulation.

The current study is the first randomized trial to compare improvement in cardiac-related health status with use of a disease-specific questionnaire to evaluate the burden of angina in patients who underwent stent-assisted angioplasty or coronary artery bypass surgery.

“While patients who underwent either intervention showed tremendous improvement in their health status at one year, they had less chest pain if they had coronary artery bypass surgery than if they had stenting,” said the study’s senior author, William S. Weintraub, M.D.

The current analysis is based on data from the Stent or Surgery trial, in which 988 patients with more than one blocked coronary artery were randomly assigned to receive either bypass surgery or percutaneous coronary intervention. Of the total, 500 had bypass surgery and 488 patients had stent-assisted angioplasty. The patients’ average age was 61 years. The majority of patients (79 percent) were male, while 14 percent had diabetes, 24 percent had acute coronary syndrome, and 45 percent had hypertension.

Patients’ cardiac-related health status was measured at baseline, at six months, and at one year using the 19-item, self-administered Seattle Angina Questionnaire. The questionnaire focused on physical limitations, angina stability and frequency, treatment satisfaction, and perception of quality of life. Overall, treatment satisfaction was high for both groups.

On a scale of 0 to 100, scores for physical limitations, angina frequency, and quality of life improved significantly in both groups, from 14.3 points to 38.2 points at one year. However, when bypass patients were compared with those who received angioplasty, the bypass patients showed greater improvement, by an average of 2 to 3 points.

“The advantage of coronary artery bypass grafting was unanticipated,” Weintraub said. “It [bypass grafting] is initially much more expensive, but the cost advantage of percutaneous coronary intervention may be lost if the procedure must be done several times.” He noted that about one in five patients who undergo angioplasty experience restenosis to such an extent that a repeat intervention is needed within a year.

“Since there were substantial improvements in chest pain and quality of life in both groups, the findings should be used more as a guide to treating patients with angina rather than viewed as an endorsement of one procedure over another,” he said. “If patients want to know which one will make them feel better, the answer is coronary artery bypass surgery.”