CABG raises quality of life in patients with ischemic left ventricular dysfunction

When treated for ischemic left ventricular dysfunction, patients who underwent CABG reported better quality-of-life compared with guideline therapy patients at different time points throughout follow-up of nearly five years. The CABG group also had lower depression scores.

More CABG patients also were reported as New York Heart Association (NYHA) Class I and Canadian Cardiovascular Society (CCS) Angina Class I in successive follow-up. These findings were part of an analysis of data collected as part of the STICH (Surgical Treatment for Ischemic Heart Failure) trial and reported Sept. 16 in Annals of Internal Medicine.

Lead author Daniel B. Mark, MD, MPH, of Duke Clinical Research Institute in Durham, N.C., and colleagues randomized 1,212 patients with ischemic left ventricular dysfunction to CABG and guideline therapy or guideline therapy alone. These patients were enrolled from 99 sites in 22 countries between July 2002 and May 2007 and follow-up occurred for a median of 56 months.

Quality of life was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ) predominantly, with some assessment through the Seattle Angina Questionnaire and the Center for Epidemiologic Studies Depression Scale, among others.

Differences in quality of life outcomes began at four months and persisted through 36 months, favoring CABG most for heart failure-specific symptoms at 12 months (5.8 points difference) and beyond, although diminishing somewhat over time. More CABG patients had clinically significant improvement in quality of life (defined as five points or more) above baseline, with the highest number reported at 12 months.

The Seattle Angina Questionnaire revealed data also in favor of CABG; at four and 12 months, patients in the CABG group reported 9.4 and 9.2 points higher, respectively, on the scale than their guideline treatment counterparts. Although the difference dropped off somewhat at later time points, the difference remained relatively high and in favor of CABG.

Statistical differences between the two groups did not occur until 24 months on the depression scale. However, at 24 months and continuing thereafter, more patients in the guideline treatment group reported depression through 36 months (24 months: CABG 24.1 percent vs. guideline 31.1 percent; 36 months: 22.4 percent vs. 29.5 percent).

They found that in addition to better reported quality of life, patients who underwent CABG also had less risk of death from cardiovascular causes (hazard ratio 0.81) as well as all-cause mortality and cardiovascular-related hospitalizations (hazard ratio 0.74).

Mark et al reported 90 percent of CABG patients had freedom from angina (CCS class I) and 35 percent to 42 percent of CABG patients were free of heart failure symptoms (NYHA class I) over the course of follow-up. However, the benefit between CABG and medical treatment diminished to the point of no difference by 48 months.

“The pattern of QOL [quality of life] treatment benefits for CABG was seen in the principal QOL measure (the KCCQ, which reflects heart failure–related QOL outcomes) and various secondary QOL outcome measures reflecting angina symptoms, physical and social functioning, and general well-being,” wrote Mark et al.

“Overall, these data describe a consistent and coherent benefit in QOL from CABG over medical therapy alone from the patient’s perspective.”