MRS vs. DES: Which one is associated with better long-term quality of life?

The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, which included patients with 3-vessel or left main coronary artery lesions, showed that myocardial revascularization surgery (MRS) turned out to be superior to angioplasty with drug-eluting stents (DES), mainly due to differences in acute myocardial infarction and repeat revascularization.

Up to this work, patient sensations (which can be analyzed objectively through different quality-of-life scores, particularly long-term scores) had never been studied. Studying this in relation to the short term makes almost no sense because angioplasty will always be superior due to patient fast recovery and less method invasiveness.

This work included the 1800 patients enrolled in the parent study, who were assessed at 1, 6, 12, 36, and 60 months by means of different tests such as the Angina Questionnaire and the 36-Item Short Form Health Survey.

Also read: “Myocardial Revascularization Surgery: One or Two Internal-Thoracic-Artery Grafts?”

At the 5-year follow-up, surgery turned out to be superior to DES angioplasty on several quality-of-life domains, including angina frequency, physical function, and emotional function.

The subgroup analysis demonstrated significant interaction between anatomic complexity (as assessed by the SYNTAX score) and angina relief (mean difference in the angina frequency score for MRS vs. angioplasty of -0.9, 3.3, and 3.9 points for low, intermediate, and high SYNTAX score patients, respectively; p = 0.048 for interaction).

Also read: “Lotus Valve Performance Related to Pacemaker Implantation in Patients After TAVR.”

Conclusion

Among patients with 3-vessel or left main coronary artery lesions, both myocardial revascularization surgery and angioplasty with drug-eluting stents were associated with substantial and sustained quality-of-life improvement at 5 years of follow-up.

Long-term angina relief was better with surgery, particularly for patients with higher anatomical complexity.

Editorial

It should be kept in mind that the SYNTAX study only used first-generation drug-eluting stents, which are now obsolete. There is evidence (Palmerini T. et al. Lancet 2012;379:1393–402, and Bangalore S. et al. Circulation 2012;125:2873–91) suggesting that next-generation DES (particularly everolimus-eluting stents) present rates of repeat revascularization and thrombosis significantly lower than paclitaxel-eluting stents. In consequence, the advantage in favor of surgery observed in the SYNTAX study may possibly be attenuated with the use of new devices.

Original title: Quality of Life After Surgery or DES in Patients with 3-Vessel or Left Main Disease.

Reference: Mouin S. Abdallah et al. J Am Coll Cardiol 2017;69:2039-50.

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