Quality of life after coronary angioplasty or continued medical treatment for angina: Three-year follow-up in the RITA-2 trial

OBJECTIVES We sought to evaluate the impact of percutaneous transluminal co ronary angioplasty (PTCA) and medical treatment on self-perceived quality o f life among patients with angina. BACKGROUND The second Randomized Intervention Treatment of Angina trial (RI TA-2) implemented initial policies of PTCA or continued medical treatment i n patients with angina, allowing assessment of long-term health consequence s. METHODS A total of 1,018 patients were randomly assigned (504 to PTCA and 5 14 to medical treatment). The short form 36 (SF-36) self-administered quali ty-of-life questionnaire was completed at randomization and three months, o ne year and three years later. To date, 98% of patients reached one year an d 67% reached three years. RESULTS The PTCA group had significantly greater improvements in physical f unctioning, vitality and general health at both three months and one year, but not at three years. These quality-of-life scores were strongly related to breathlessness, angina grade and treadmill exercise time both at baselin e and at one year. The treatment differences in quality of life are explain ed by the PTCA group's improvements in breathlessness, angina and exercise time. The attenuation of treatment difference at three years is partly attr ibuted to 27% of medically treated patients receiving nonrandomized interve ntions in the interim. For both groups, there were also improvements in rat ings of physical role functioning, emotional role functioning, social funct ioning, pain and mental health, but for these the superiority of PTCA over medical treatment was less pronounced. After one year, 33% and 22% of the P TCA and medical groups, respectively, rated their health much better. CONCLUSIONS Coronary angioplasty substantially improves patient-perceived q uality of life, especially physical functioning and vitality, as compared w ith continued medical treatment. These differences are attributed to allevi ation of cardiac symptoms (specifically, breathlessness and angina), but mu st be balanced against the small procedure-related risks of PTCA. (C) 2000 by the American College of Cardiology.