Original Article Neuropsychological and Psychiatric Outcomes Following Coronary Surgery or Angioplasty: A Comparative Study Mark A. Sader, MB BS, FRACP,~ Laurie A. Miller, PhD,2f5 Diana Caine, rhD,2,5 Robyn J. McCredie, ~sc,l,~ Melissa J. Corr, MB BS, FRANZCP,~ Michael Robertson, MB BS, FRANZCP,~ John D. G. Watson, rhD, FRACP~,~ and David S. Celermajer, PhD, FRAC@J~ Departments of lCardiology, 2Neuropsyckology, 3Psyckiafry and 4Neurology, Royal Prince Alfved Hospital and 5Universify of Sydney, Camperdown, New South Wales, Australia Background: Medical outcomes following coronary artery bypass grafting (CABG) or percutan- eous transluminal coronary angioplasty (PTCA) are similar, but few studies have compared neuropsychological outcomes after these procedures. Methods: A retrospective study compared detailed neurocognitive and psychosocial functioning in 32 patients (CABG, n = 16; PTCA, n = 16) aged 61+6years, 9-15 months after coronary revascularisation. Subjects were tested for executive functioning, speed of processing/attention and learning/memory, significant psychopathology (General Health Questionnaire, GHQ) and psychosocial functioning (Short Form (SF)-36 health survey). In the prospective study, 55 patients completed GHQ and SF-36 surveys, the day prior to and 6 months following PTCA. Results: There were no significant differences between the CABG and PTCA groups for neuropsychological or psychosocial end-points (P > 0.201. Executive functioning in both groups, however, was worse than for healthy population controls (P < 0.01). The PTCA patients were significantly more likely than CABG patients to have psychiatric abnormality (GHQ Score >4; P < 0.01). After PTCA, however, there was a significant improvement in the GHQ and SF-36 scores (P < 0.05). Conclusions: Although executive function is often impaired after coronary revascularisation, neuropsychological status appears equivalent after CABG or PTCA. Psychiatric pathology is common in patients undergoing PTCA, but improves after this intervention. (Heart, Lung and Circulation 2002; 11: 95-101) Key words: cognitive, coronary angioplasty, coronary bypass, psychosocial. S urvival rates appear to be equivalent following either percutaneous transluminal coronary angi- oplasty (PTCA) or coronary artery bypass grafting (CABG) as initial revascularisation procedures for adults with multi-vessel disease, with the exception of diabetic Correspondence: Professor David Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia. Email: davidc@card.rpa.cs.nsw.gov.au patients.lr2 Because medical outcomes are similar, any significant differences in long-term cognitive and func- tional outcomes could influence therapeutic decision making. Cognitive impairment following surgical treatment for coronary artery disease has been investigated exten- sively. 3-7 A number of studies have shown a marked decline in cognitive function in the early postoperative phase after CABG.8-1° Relatively rapid improvement has been demonstrated in a majority of cases3,4,*o,11 but