Cumulating quality of life results in controlled trials of coronary artery bypass graft surgery

Abstract

Many studies evaluating the effectiveness of coronary artery bypass graft surgery allude to the quality of life benefit resulting from surgery. However, no comprehensive empirical estimate of the absolute or relative magnitude of this benefit is currently available. This paper presents a data synthesis of the research literature on bypass surgery to derive such an estimate. It uses follow-up measures of the percent of patients who were angina-free within both the surgical and medical groups of 14 controlled trials to estimate the quality of life benefit following surgery. Results based on the longest reported follow-up period suggest that the chances are approximately 25 to 40% greater than patients will be angina-free if they receive surgery rather than medical treatment. Estimates of benefit are about 15% less in randomized controlled trials compared to controlled trials that used a matching strategy. These results are unlikely to be affected by related factors such as the percentage of patients who crossover from the medical group to the surgical group or the specific method of calculating anginal relief used in this research report. However, differential patient selection may account for the observed design effect.