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The association between self-reported health status and adverse events: a comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI)

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Abstract

Purpose

While several studies have investigated clinical outcomes following coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI), studies investigating self-reported health and the association with adverse outcomes are limited. Thus, the aim was to investigate differences in health-related quality of life (HRQoL), anxiety and depression at discharge and the association with a composite endpoint of the first event of acute cardiac readmission, revascularisation or 1-year mortality among patients undergoing CABG vs. PCI.

Methods

Data from the national cohort study, DenHeart, were used, including measures of HRQoL; EuroQoL-5D-5L (EQ-5D Index Score and VAS) and HeartQoL (Global, Physical and Emotional), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) and register-based follow-up. A total of 7000 patients were included (CABG n = 652, PCI n = 6348) (median age 65, 75% men). Cox Proportional Hazard models were performed among a propensity-matched population of responders (n = 520).

Results

HRQoL was significantly better among patients undergoing PCI vs. CABG, but with no differences in time to readmission or revascularisation. HRQoL, anxiety and depression were significantly associated with the risk of the composite endpoint among the PCI group (Hazard Ratio, HR (95% confidence intervals, CI) [EQ-5D index score 3.07 (1.67–5.67), EQ-5D VAS 0.97 (0.96–0.99), HeartQol Global 0.61 (0.38–0.95), HeartQol Emotional 0.56 (0.39–0.80), HADS-D ≥ 8 3.12 (1.61–6.01), HADS-A ≥ 8 2.08 (1.14–3.80)].

Conclusion

Patients undergoing PCI reported better HRQoL at discharge compared with patients undergoing CABG, whereas readmission rates were similar. Self-reported health was associated with the risk of adverse events among patients undergoing PCI, but not among patients undergoing CABG.

Clinical trial registration

NCT01926145.

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References

  1. Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., et al. (2016). Epidemiology of coronary heart disease and acute coronary syndrome. Annals of Translational Medicine, 4(13), 256. https://doi.org/10.21037/atm.2016.06.33. (publishedOnlineFirst:2016/08/09).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sousa-Uva, M., Neumann, F. J., Ahlsson, A., et al. (2019). 2018 ESC/EACTS Guidelines on myocardial revascularization. European Journal of Cardio-Thoracic Surgery, 55(1), 4–90. https://doi.org/10.1093/ejcts/ezy289. (publishedOnlineFirst:2018/08/31).

    Article  PubMed  Google Scholar 

  3. Head, S. J., Milojevic, M., Taggart, D. P., et al. (2017). Current practice of state-of-the-art surgical coronary revascularization. Circulation, 136(14), 1331–1345. https://doi.org/10.1161/CIRCULATIONAHA.116.022572. (publishedOnlineFirst:2017/10/04).

    Article  PubMed  Google Scholar 

  4. Byrne, R. A., Stone, G. W., Ormiston, J., et al. (2017). Coronary balloon angioplasty, stents, and scaffolds. Lancet, 390(10096), 781–792. https://doi.org/10.1016/S0140-6736(17)31927-X. (publishedOnlineFirst:2017/08/24).

    Article  PubMed  Google Scholar 

  5. Mulukutla, S. R., Gleason, T. G., Sharbaugh, M., et al. (2019). Coronary bypass versus percutaneous revascularization in multivessel coronary artery disease. Annals of Thoracic Surgery, 108(2), 474–480. https://doi.org/10.1016/j.athoracsur.2019.02.064. (publishedOnlineFirst:2019/05/06).

    Article  PubMed  Google Scholar 

  6. Makikallio, T., Holm, N. R., Lindsay, M., et al. (2016). Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet, 388(10061), 2743–2752. https://doi.org/10.1016/S0140-6736(16)32052-9. (publishedOnlineFirst:2016/11/05).

    Article  PubMed  Google Scholar 

  7. Mohr, F. W., Morice, M. C., Kappetein, A. P., et al. (2013). Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 381(9867), 629–638. https://doi.org/10.1016/S0140-6736(13)60141-5. (publishedOnlineFirst:2013/02/27).

    Article  PubMed  Google Scholar 

  8. Stone, G. W., Kappetein, A. P., Sabik, J. F., et al. (2019). Five-year outcomes after PCI or CABG for left main coronary disease. The New England Journal of Medicine, 381(19), 1820–1830. https://doi.org/10.1056/NEJMoa1909406. (publishedOnlineFirst:2019/09/29).

    Article  PubMed  Google Scholar 

  9. Baron, S. J., Chinnakondepalli, K., Magnuson, E. A., et al. (2017). Quality-of-life after everolimus-eluting stents or bypass surgery for left-main disease: results from the EXCEL trial. Journal of the American College of Cardiology, 70(25), 3113–3122. https://doi.org/10.1016/j.jacc.2017.10.036. (publishedOnlineFirst:2017/11/04).

    Article  PubMed  Google Scholar 

  10. McGrath, B. M., Norris, C. M., Hardwicke-Brown, E., et al. (2017). Quality of life following coronary artery bypass graft surgery vs. percutaneous coronary intervention in diabetics with multivessel disease: a five-year registry study. European Heart Journal-Quality of Care and Clinical Outcomes, 3(3), 216–223. https://doi.org/10.1093/ehjqcco/qcw055. (published Online First: 2017/08/26).

    Article  PubMed  Google Scholar 

  11. Kulik, A. (2017). Quality of life after coronary artery bypass graft surgery versus percutaneous coronary intervention: what do the trials tell us? Current Opinion in Cardiology, 32(6), 707–714. https://doi.org/10.1097/HCO.0000000000000458. (publishedOnlineFirst:2017/08/24).

    Article  PubMed  Google Scholar 

  12. Abdallah, M. S., Wang, K., Magnuson, E. A., et al. (2017). Quality of life after surgery or DES in patients with 3-vessel or left main disease. Journal of the American College of Cardiology, 69(16), 2039–2050. https://doi.org/10.1016/j.jacc.2017.02.031. (publishedOnlineFirst:2017/04/22).

    Article  PubMed  Google Scholar 

  13. Abdallah, M. S., Wang, K., Magnuson, E. A., et al. (2013). Quality of life after PCI vs CABG among patients with diabetes and multivessel coronary artery disease: a randomized clinical trial. JAMA, 310(15), 1581–1590. https://doi.org/10.1001/jama.2013.279208. (publishedOnlineFirst:2013/10/17).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Takagi, H., Ando, T., Umemoto, T., et al. (2017). Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis. Heart and Vessels, 32(12), 1458–1468. https://doi.org/10.1007/s00380-017-1022-3. (publishedOnlineFirst:2017/07/14).

    Article  PubMed  Google Scholar 

  15. Geulayov, G., Novikov, I., Dankner, D., et al. (2018). Symptoms of depression and anxiety and 11-year all-cause mortality in men and women undergoing coronary artery bypass graft (CABG) surgery. Journal of Psychosomatic Research, 105, 106–114. https://doi.org/10.1016/j.jpsychores.2017.11.017. (publishedOnlineFirst:2018/01/16).

    Article  PubMed  Google Scholar 

  16. Stenman, M., Holzmann, M. J., & Sartipy, U. (2016). Association between preoperative depression and long-term survival following coronary artery bypass surgery—a systematic review and meta-analysis. International Journal of Cardiology, 222, 462–466. https://doi.org/10.1016/j.ijcard.2016.07.216. (publishedOnlineFirst:2016/08/10).

    Article  PubMed  Google Scholar 

  17. Yu, H. Y., Park, Y. S., & Son, Y. J. (2017). Combined effect of left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention: a 12-month follow-up. European Journal of Cardiovascular Nursing, 16(1), 37–45. https://doi.org/10.1177/1474515116634530. (publishedOnlineFirst:2016/02/19).

    Article  PubMed  Google Scholar 

  18. Iles-Smith, H., McGowan, L., Campbell, M., et al. (2015). A prospective cohort study investigating readmission, symptom attribution and psychological health within six months of primary percutaneous coronary intervention. European Journal of Cardiovascular Nursing, 14(6), 506–515. https://doi.org/10.1177/1474515114543227. (publishedOnlineFirst:2014/07/16).

    Article  PubMed  Google Scholar 

  19. Meyer, T., Hussein, S., Lange, H. W., et al. (2015). Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. European Journal of Preventive Cardiology, 22(1), 75–82. https://doi.org/10.1177/2047487313505244. (publishedOnlineFirst:2013/09/21).

    Article  PubMed  Google Scholar 

  20. van Dijk, M. R., Utens, E. M., Dulfer, K., et al. (2016). Depression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up. European Journal of Preventive Cardiology, 23(5), 552–558. https://doi.org/10.1177/2047487315571889. (publishedOnlineFirst:2015/02/11).

    Article  PubMed  Google Scholar 

  21. de Jager, T. A. J., Dulfer, K., Radhoe, S., et al. (2018). Predictive value of depression and anxiety for long-term mortality: differences in outcome between acute coronary syndrome and stable angina pectoris. International Journal of Cardiology, 250, 43–48. https://doi.org/10.1016/j.ijcard.2017.10.005. (publishedOnlineFirst:2017/10/11).

    Article  PubMed  Google Scholar 

  22. Berg, S. K., Svanholm, J., Lauberg, A., et al. (2014). Patient-reported outcomes at hospital discharge from Heart Centres, a national cross-sectional survey with a register-based follow-up: the DenHeart study protocol. British Medical Journal Open, 4(5), e004709. https://doi.org/10.1136/bmjopen-2013-004709. (publishedOnlineFirst:2014/05/06).

    Article  Google Scholar 

  23. NOMESCO, N. (2011). NOMESCO Classification of Surgical Procedures (NCSP), version 1.16. Copenhagen. Retrieved from http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-4605.

  24. Pedersen, C. B. (2011). The danish civil registration system. Scandinavian Journal of Public Health, 39(7 Suppl), 22–25. https://doi.org/10.1177/1403494810387965. (publishedOnlineFirst:2011/08/04).

    Article  PubMed  Google Scholar 

  25. Lynge, E., Sandegaard, J. L., & Rebolj, M. (2011). The danish national patient register. Scandinavian Journal of Public Health, 39(7 Suppl), 30–33. https://doi.org/10.1177/1403494811401482. (publishedOnlineFirst:2011/08/04).

    Article  PubMed  Google Scholar 

  26. Jensen, V. M., & Rasmussen, A. W. (2011). Danish education registers. Scandinavian Journal of Public Health, 39(7 Suppl), 91–94. https://doi.org/10.1177/1403494810394715. (publishedOnlineFirst:2011/08/04).

    Article  PubMed  Google Scholar 

  27. Tu, J. V., Austin, P. C., Walld, R., et al. (2001). Development and validation of the Ontario acute myocardial infarction mortality prediction rules. Journal of the American College of Cardiology, 37(4), 992–997. https://doi.org/10.1016/s0735-1097(01)01109-3. (publishedOnlineFirst:2001/03/27).

    Article  CAS  PubMed  Google Scholar 

  28. Rabin, R., & de Charro, F. (2001). EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343. https://doi.org/10.3109/07853890109002087. (publishedOnlineFirst:2001/08/09).

    Article  CAS  PubMed  Google Scholar 

  29. Oldridge, N., Saner, H., McGee, H. M., et al. (2005). The Euro Cardio-QoL Project. An international study to develop a core heart disease health-related quality of life questionnaire, the HeartQoL. European Journal of Cardiovascular Prevention & Rehabilitation, 12(2), 87–94. https://doi.org/10.1097/01.hjr.0000159408.05180.0e. (published Online First: 2005/03/24).

    Article  Google Scholar 

  30. Oldridge, N., Hofer, S., McGee, H., et al. (2014). The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. European Journal of Preventive Cardiology, 21(1), 90–97. https://doi.org/10.1177/2047487312450544. (published Online First: 2012/07/24).

    Article  PubMed  Google Scholar 

  31. Oldridge, N., Hofer, S., McGee, H., et al. (2014). The HeartQoL: part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. European Journal of Preventive Cardiology, 21(1), 98–106. https://doi.org/10.1177/2047487312450545. (published Online First: 2012/07/24).

    Article  PubMed  Google Scholar 

  32. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x. (publishedOnlineFirst:1983/06/01).

    Article  CAS  PubMed  Google Scholar 

  33. De Smedt, D., Clays, E., Doyle, F., et al. (2013). Validity and reliability of three commonly used quality of life measures in a large European population of coronary heart disease patients. International Journal of Cardiology, 167(5), 2294–2299. https://doi.org/10.1016/j.ijcard.2012.06.025. (publishedOnlineFirst:2012/07/04).

    Article  PubMed  Google Scholar 

  34. De Smedt, D., Clays, E., Hofer, S., et al. (2016). Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: the EUROASPIRE IV study of the European society of cardiology. European Journal of Preventive Cardiology, 23(7), 714–721. https://doi.org/10.1177/2047487315604837. (publishedOnlineFirst:2015/09/12).

    Article  PubMed  Google Scholar 

  35. WMA. (1964). Declaration of Helsinki. In H. 18th WMA General Assembly, Finland (Ed.), (Vol. 18th).

  36. Rosenbaum, P. R., & Rubin, D. B. (1983). The central role of the propensity score in observational studies for causal effects. Biometrika, 70(1), 41–55.

    Article  Google Scholar 

  37. Thoemmes, F. J., & Kim, E. S. (2011). A systematic review of propensity score methods in the social sciences. Multivariate Behavioral Research, 46(1), 90–118. https://doi.org/10.1080/00273171.2011.540475. (publishedOnlineFirst:2011/02/07).

    Article  PubMed  Google Scholar 

  38. Prentice, R. L., Kalbfleisch, J. D., Peterson, A. V., Jr., et al. (1978). The analysis of failure times in the presence of competing risks. Biometrics, 34(4), 541–554. (published Online First: 1978/12/01).

    Article  CAS  PubMed  Google Scholar 

  39. Fine, J. P., & Gray, R. J. (1999). A proportional hazards model for the subdistribution of a competing risk. Journal of the American statistical association, 94(446), 496–509.

    Article  Google Scholar 

  40. Vaccarino, V., Badimon, L., Bremner, J. D., et al. (2019). Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. European Heart Journal. https://doi.org/10.1093/eurheartj/ehy913.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Xiao, Y., Li, W., Zhou, J., et al. (2019). Impact of depression and/or anxiety on patients with percutaneous coronary interventions after acute coronary syndrome: a protocol for a real-world prospective cohort study. British Medical Journal Open, 9(9), e027964. https://doi.org/10.1136/bmjopen-2018-027964. (publishedOnlineFirst:2019/09/08).

    Article  Google Scholar 

  42. Berg, S. K., Rasmussen, T. B., Herning, M., et al. (2019). Cognitive behavioural therapy significantly reduces anxiety in patients with implanted cardioverter defibrillator compared with usual care: Findings from the Screen-ICD randomised controlled trial. European Journal of Preventive Cardiology. https://doi.org/10.1177/2047487319874147. (published Online First: 2019/10/03).

    Article  PubMed  Google Scholar 

  43. Borregaard, B., Pedersen, S. S., Berg, S. K., et al. (2019). What to expect after open heart valve surgery? Changes in health-related quality of life. Quality of Life Research. https://doi.org/10.1007/s11136-019-02400-9. (publishedOnlineFirst:2019/12/26).

    Article  PubMed  Google Scholar 

  44. Borregaard, B., Sorensen, J., Ekholm, O., et al. (2018). Sociodemographic, clinical and patient-reported outcomes and readmission after heart valve surgery. The Journal of Heart Valve Disease, 27(1), 78–86. (published Online First: 2018/12/19).

    PubMed  Google Scholar 

  45. Berg, S. K., Thorup, C. B., Borregaard, B., et al. (2019). Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: findings from the national DenHeart survey. European Journal of Preventive Cardiology, 26(6), 624–637. https://doi.org/10.1177/2047487318769766. (publishedOnlineFirst:2018/04/12).

    Article  PubMed  Google Scholar 

  46. Vamosi, M., Lauberg, A., Borregaard, B., et al. (2019). Patient-reported outcomes predict high readmission rates among patients with cardiac diagnoses. Findings from the DenHeart study. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2019.09.046. (published Online First: 2019/11/22).

    Article  PubMed  Google Scholar 

  47. Zhang, W. Y., Nan, N., Song, X. T., et al. (2019). Impact of depression on clinical outcomes following percutaneous coronary intervention: a systematic review and meta-analysis. British Medical Journal Open, 9(8), e026445. https://doi.org/10.1136/bmjopen-2018-026445. (publishedOnlineFirst:2019/08/23).

    Article  Google Scholar 

  48. Berg, S. K., Rasmussen, T. B., Thrysoee, L., et al. (2017). DenHeart: differences in physical and mental health across cardiac diagnoses at hospital discharge. Journal of Psychosomatic Research, 94, 1–9. https://doi.org/10.1016/j.jpsychores.2017.01.003. (publishedOnlineFirst:2017/02/12).

    Article  PubMed  Google Scholar 

  49. Munyombwe, T., Hall, M., Dondo, T. B., et al. (2020). Quality of life trajectories in survivors of acute myocardial infarction: a national longitudinal study. Heart, 106(1), 33–39. https://doi.org/10.1136/heartjnl-2019-315510. (publishedOnlineFirst:2019/11/09).

    Article  PubMed  Google Scholar 

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Acknowledgements

A special thanks to the patients who took their time to participate in the survey, and to the cardiac nurses involved in the data collection.

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None.

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Authors and Affiliations

  1. Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark

    Stine Nørris Nielsen, Jens Flensted Lassen, Lars Thrysoee, Jacob Eifer Møller, Lisette Okkels Jensen & Britt Borregaard

  2. University of Southern Denmark, Odense, Denmark

    Stine Nørris Nielsen, Jens Flensted Lassen, Lars Thrysoee, Jacob Eifer Møller, Lisette Okkels Jensen & Britt Borregaard

  3. Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark

    Trine Bernholdt Rasmussen

  4. Department of Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Selina Kikkenborg Berg & Anne Vinggaard Christensen

  5. University of Copenhagen, Copenhagen, Denmark

    Selina Kikkenborg Berg

  6. Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark

    Anne Langhoff Thuesen & Britt Borregaard

  7. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

    Ola Ekholm

  8. Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark

    Rikke Mols

  9. Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark

    Charlotte Brun Thorup

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  1. Stine Nørris Nielsen
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Nielsen, S.N., Rasmussen, T.B., Lassen, J.F. et al. The association between self-reported health status and adverse events: a comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Qual Life Res 29, 3017–3029 (2020). https://doi.org/10.1007/s11136-020-02573-8

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