COGNITIVE FUNCTION 5 YEARS AFTER RANDOMIZATION TO CORONARY ANGIOPLASTY OR CORONARY-ARTERY BYPASS GRAFT-SURGERY

Background Coronary bypass surgery often leads to shortterm cognitive dysfunction, whereas coronary angioplasty does not. Perioperative cogn itive dysfunction usually resolves, al though a subgroup of surgical p atients may continue to exhibit long-term cognitive dysfunction. The p urpose of this study was to compare cognitive function 5 years after r andomization to a strategy of either initial coronary surgery or initi al angioplasty. Methods and Results Five centers in the Bypass Angiopl asty Revascularization Investigation participated in this ancillary st udy. Patients with multivessel coronary disease randomized to angiopla sty or surgery were eligible at the time of their 5-year clinic visit. A battery of five measures previously shown to be sensitive to periop erative changes in cognitive function was administered, including the Logical and Figural Memory Scales from the Wechsler Memory Scale, the Digit Symbol and Digit Span subtests from the Wechsler Adult Intellige nce Scale, and Part B of the Reitan Trail Making Test. The 125 study p atients were generally similar to the 133 patients who were eligible b ut did not participate, although study participants were significantly younger (P=.003). The 64 patients randomly assigned to angioplasty ha d baseline characteristics similar to those of 61 patients randomly as signed to surgery. Cognitive function scores were not significantly di fferent between angioplasty or surgery patients in an intention-to-tre at analysis (P=.57). There also was no difference in cognitive functio n scores when the data were analyzed according to whether the patient had ever undergone bypass surgery (P=.59). Conclusions Long-term cogni tive function is similar after coronary bypass surgery and coronary an gioplasty in the majority of patients.