Angina Less Frequent After CABG Than After PCI

In patients with three-vessel or left main coronary artery disease, coronary artery bypass graft surgery provides greater relief from angina at 6 months and at 12 months after revascularization than does per?cutaneous coronary intervention with paclitaxel-eluting stents, according to a report in the New England Journal of Medicine.

EMBARGOED UNTIL 5 PM WED. 3/16

This benefit with CABG was consistent across a broad range of patient characteristics, said Dr. David J. Cohen of Saint Lukes Mid America Heart Institute, University of Missouri Kansas City, and his associates in the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. SYNTAX was funded by Boston Scientific, maker of the paclitaxel-eluting stent.

SYNTAX was an international randomized trial in which 1,800 patients with three-vessel or left main coronary artery disease underwent either CABG or percutaneous coronary intervention (PCI) with placement of paclitaxel-eluting stents in 2005-2007.

The rate of the composite primary efficacy end point of death, myocardial infarction, stroke, or repeat revascularization was found to be lower with CABG at 1 year.

The current analysis was a quality-of-life substudy of SYNTAX aimed at determining whether the two approaches differed with regard to relief from angina and quality of life. It included 903 patients who had been randomly assigned to PCI with stents and 897 who had been assigned to CABG.

At baseline, approximately 12% of the subjects reported having daily angina and 20% reported no angina; the remaining subjects reported occasional angina.

Both PCI and CABG led to significant improvements in disease-specific and general health status over the course of 12 months, according to the investigators.

The primary quality-of-life end point was the score on the Seattle Angina Questionnaire angina frequency subscale. The improvement in this score was slightly but significantly greater with CABG than with PCI at 6 and 12 months.

?There were marked benefits with PCI as compared with CABG in general health-related quality of life as assessed by the SF-36 [Medical Outcomes Study 36-Item Short Form Health Survey] as well as EQ-SD [European Quality of Life

********* TEXT BREAK *********5-Dimensions instrument] at 1 month, but these differences had largely disappeared by 6 months, Dr. Cohen and his col?leagues reported (N. Engl. J. Med. 2011;364:1016-26).

<[stk 2]>Subgroup analysis showed that CABGs superiority in reducing the frequency of angina persisted across a broad range of patients. <[etk]>

<[stk 2]>Subjects who had reported daily or weekly angina at baseline showed significantly better relief after CABG than after PCI, although they reported that the extent of the benefit was small (76.3% vs. 71.6%, respectively, P = .05). <[etk]>

<[stk 3]>However, the majority of the study subjects had reported less frequent or no angina at baseline, and there was no significant difference in relief from angina between the two approaches in this large subgroup. <[etk]>

The researchers noted that these findings ?reflect only the first year of follow-up after revascularization; whether similar effects are observed over the long term is currently un?known.?

I have checked the following facts in my story:

MM     Drug names and dosages MSL

NA     Lab test values and their units NA

MM     Nos. are correct and add up, and percentages based on those nos. are correct MSL

MM    Citation MSL

MM     Investigators? names and affiliations MSL

MM     All other proper names (e.g., clinical trials; geographic, company, and test names) MSL

MM     Investigators? conflicts of interest and sponsor of study MSL

Best contact number = 301-325-5890; email = [email protected]

Dr. Cohen and his associates reported that they had ties to numerous industry sources, including Boston Scientific. 

********* UNDERSET  1  LINES *********

In patients with three-vessel or left main coronary artery disease, coronary artery bypass graft surgery provides greater relief from angina at 6 months and at 12 months after revascularization than does per?cutaneous coronary intervention with paclitaxel-eluting stents, according to a report in the New England Journal of Medicine.

EMBARGOED UNTIL 5 PM WED. 3/16

This benefit with CABG was consistent across a broad range of patient characteristics, said Dr. David J. Cohen of Saint Lukes Mid America Heart Institute, University of Missouri Kansas City, and his associates in the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. SYNTAX was funded by Boston Scientific, maker of the paclitaxel-eluting stent.

SYNTAX was an international randomized trial in which 1,800 patients with three-vessel or left main coronary artery disease underwent either CABG or percutaneous coronary intervention (PCI) with placement of paclitaxel-eluting stents in 2005-2007.

The rate of the composite primary efficacy end point of death, myocardial infarction, stroke, or repeat revascularization was found to be lower with CABG at 1 year.

The current analysis was a quality-of-life substudy of SYNTAX aimed at determining whether the two approaches differed with regard to relief from angina and quality of life. It included 903 patients who had been randomly assigned to PCI with stents and 897 who had been assigned to CABG.

At baseline, approximately 12% of the subjects reported having daily angina and 20% reported no angina; the remaining subjects reported occasional angina.

Both PCI and CABG led to significant improvements in disease-specific and general health status over the course of 12 months, according to the investigators.

The primary quality-of-life end point was the score on the Seattle Angina Questionnaire angina frequency subscale. The improvement in this score was slightly but significantly greater with CABG than with PCI at 6 and 12 months.

?There were marked benefits with PCI as compared with CABG in general health-related quality of life as assessed by the SF-36 [Medical Outcomes Study 36-Item Short Form Health Survey] as well as EQ-SD [European Quality of Life

********* TEXT BREAK *********5-Dimensions instrument] at 1 month, but these differences had largely disappeared by 6 months, Dr. Cohen and his col?leagues reported (N. Engl. J. Med. 2011;364:1016-26).

<[stk 2]>Subgroup analysis showed that CABGs superiority in reducing the frequency of angina persisted across a broad range of patients. <[etk]>

<[stk 2]>Subjects who had reported daily or weekly angina at baseline showed significantly better relief after CABG than after PCI, although they reported that the extent of the benefit was small (76.3% vs. 71.6%, respectively, P = .05). <[etk]>

<[stk 3]>However, the majority of the study subjects had reported less frequent or no angina at baseline, and there was no significant difference in relief from angina between the two approaches in this large subgroup. <[etk]>

The researchers noted that these findings ?reflect only the first year of follow-up after revascularization; whether similar effects are observed over the long term is currently un?known.?

I have checked the following facts in my story:

MM     Drug names and dosages MSL

NA     Lab test values and their units NA

MM     Nos. are correct and add up, and percentages based on those nos. are correct MSL

MM    Citation MSL

MM     Investigators? names and affiliations MSL

MM     All other proper names (e.g., clinical trials; geographic, company, and test names) MSL

MM     Investigators? conflicts of interest and sponsor of study MSL

Best contact number = 301-325-5890; email = [email protected]

Dr. Cohen and his associates reported that they had ties to numerous industry sources, including Boston Scientific. 

********* UNDERSET  1  LINES *********

In patients with three-vessel or left main coronary artery disease, coronary artery bypass graft surgery provides greater relief from angina at 6 months and at 12 months after revascularization than does per?cutaneous coronary intervention with paclitaxel-eluting stents, according to a report in the New England Journal of Medicine.

EMBARGOED UNTIL 5 PM WED. 3/16

This benefit with CABG was consistent across a broad range of patient characteristics, said Dr. David J. Cohen of Saint Lukes Mid America Heart Institute, University of Missouri Kansas City, and his associates in the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. SYNTAX was funded by Boston Scientific, maker of the paclitaxel-eluting stent.

SYNTAX was an international randomized trial in which 1,800 patients with three-vessel or left main coronary artery disease underwent either CABG or percutaneous coronary intervention (PCI) with placement of paclitaxel-eluting stents in 2005-2007.

The rate of the composite primary efficacy end point of death, myocardial infarction, stroke, or repeat revascularization was found to be lower with CABG at 1 year.

The current analysis was a quality-of-life substudy of SYNTAX aimed at determining whether the two approaches differed with regard to relief from angina and quality of life. It included 903 patients who had been randomly assigned to PCI with stents and 897 who had been assigned to CABG.

At baseline, approximately 12% of the subjects reported having daily angina and 20% reported no angina; the remaining subjects reported occasional angina.

Both PCI and CABG led to significant improvements in disease-specific and general health status over the course of 12 months, according to the investigators.

The primary quality-of-life end point was the score on the Seattle Angina Questionnaire angina frequency subscale. The improvement in this score was slightly but significantly greater with CABG than with PCI at 6 and 12 months.

?There were marked benefits with PCI as compared with CABG in general health-related quality of life as assessed by the SF-36 [Medical Outcomes Study 36-Item Short Form Health Survey] as well as EQ-SD [European Quality of Life

********* TEXT BREAK *********5-Dimensions instrument] at 1 month, but these differences had largely disappeared by 6 months, Dr. Cohen and his col?leagues reported (N. Engl. J. Med. 2011;364:1016-26).

<[stk 2]>Subgroup analysis showed that CABGs superiority in reducing the frequency of angina persisted across a broad range of patients. <[etk]>

<[stk 2]>Subjects who had reported daily or weekly angina at baseline showed significantly better relief after CABG than after PCI, although they reported that the extent of the benefit was small (76.3% vs. 71.6%, respectively, P = .05). <[etk]>

<[stk 3]>However, the majority of the study subjects had reported less frequent or no angina at baseline, and there was no significant difference in relief from angina between the two approaches in this large subgroup. <[etk]>

The researchers noted that these findings ?reflect only the first year of follow-up after revascularization; whether similar effects are observed over the long term is currently un?known.?

I have checked the following facts in my story:

MM     Drug names and dosages MSL

NA     Lab test values and their units NA

MM     Nos. are correct and add up, and percentages based on those nos. are correct MSL

MM    Citation MSL

MM     Investigators? names and affiliations MSL

MM     All other proper names (e.g., clinical trials; geographic, company, and test names) MSL

MM     Investigators? conflicts of interest and sponsor of study MSL

Best contact number = 301-325-5890; email = [email protected]

Dr. Cohen and his associates reported that they had ties to numerous industry sources, including Boston Scientific. 

********* UNDERSET  1  LINES *********