Quality of life after coronary revascularization in the United States and Canada

Cardiac procedures are performed less frequently in Canada than in the Unit ed States (US), yet rates of cardiac death and myocardial infarction are si milar, We therefore sought to compare long-term symptoms find quality of li fe in Canadian and American patients undergoing initial coronary revascular ization, The 161 patients enrolled in the Bypass Angioplasty Revascularizat ion Investigation at the Montreal Heart institute were compared with 934 pa tients enrolled at 7 US sites. patients' outcomes were documented far 5 yea rs after random assignment to percutaneous transluminal coronary angioplast y or coronary artery bypass graft surgery. Functional status was assessed u sing the Duke Activity Status index. Canadian patients were significantly y ounger and had more angina at study entry. Death and nonfatal myocardial in farction were not significantly different between Canadian and US patients after adjustment for baseline risk. Canadian patients had significantly gre eter improvements in functional status at 1-year follow-up (Duke Activity S tatus Index score + 13.5 vs + 6.0, p = 0.002), but this difference progress ively narrowed over 5 years. Angina was equally prevalent in Canadian and U S patients at 1 year (16% vs 19%), but significantly more prevalent in Cana dian patients at 5 years (36% vs 16%, p = 0.001), Repeat revascularization procedures were performed less often over 5 years among Canadian patients ( 26% vs 34%, p = 0.08), especially coronary artery bypass graft surgery afte r initial percutaneous transluminal coronary angioplasty (18% vs 32%, p = 0 .03). These results suggest more anginal symptoms are required in Canada be fore coronary revascularization, but as a result Canadians receive greater improvements in quality of life after the procedure. (C)2000 by Excerpta Me dica, Inc.