Quality of Life Study Finds PCI Has Slight Advantage Over Medication for CVD

BUFFALO, N.Y. -- The latest findings on the comparison of medication versus percutaneous coronary intervention (PCI), the term currently used for angioplasty and stenting, for stable coronary artery disease -- this time assessing quality of life -- have shown that while both groups' health status and quality of life improved, PCI had a slight advantage over medical treatment alone during the first two years.

Persons suffering from more severe angina received greater benefit from PCI and medication than those suffering from milder angina, the study showed, but even these improvements were not sustained long-term.

Significantly, patients' health improved with either treatment.

These quality-of-life findings from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) appear in the Aug. 14 edition of the New England Journal of Medicine.

William E. Boden, M.D., clinical chief of the Division of Cardiovascular Medicine at the University at Buffalo School of Medicine and Biomedical Sciences and medical director of cardiovascular services at Kaleida Health, is senior author on the current study.

Boden, who also is a professor of medicine in the UB medical school, was lead author on the initial COURAGE trial findings published in NEJM last March, which compared survival and major cardiovascular events or death in patients with stable heart disease.

"The observations in this report are very important because the detailed quality-of-life assessment obtained during the average 4.5 year follow-up was based on patients' own perceptions of their well-being and symptom status," Boden said. "We have known for years that PCI relieves angina, but this is really the first careful study that has attempted to quantify the degree and extent to which quality of life parameters changed over time among patients who received either PCI or medical treatment alone."

In assembling the quality of life data, COURAGE researchers assessed 2,287 trial participants by using the Seattle Angina Questionnaire, which measures physical limitation, angina stability, angina frequency, treatment satisfaction and overall quality of life in a self-administered 19-item patient survey at multiple time points.

Participants also completed the RAND-36 survey, a general health questionnaire that measures overall physical and mental functioning.

The COURAGE trial was conducted between 1999 and 2004. It compared survival and heart attack rates in 2,287 persons with stable heart disease who were randomized to receive either optimal medical therapy (OMT) alone or OMT plus PCI, as well as quality-of-life issues.

"What these important results mean to everyday patients with stable angina is that they can expect substantial symptomatic improvement, regardless of whether they receive PCI or intensive medical therapy," said Boden.

"The study findings should reassure both physicians and patients that optimal medical therapy can be used safely and effectively as a first-line treatment approach, with PCI reserved for patients who do not have a positive treatment response, or who may have more severe chest pain symptoms when they are first diagnosed."

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. The School of Medicine and Biomedical Sciences is one of the five schools comprising UB's Academic Health Center. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.