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Quality of life after late invasive therapy for occluded arteries.
Mark, Daniel B; Pan, Wenqin; Clapp-Channing, Nancy E; Anstrom, Kevin J; Ross, John R; Fox, Rebecca S; Devlin, Gerard P; Martin, C Edwin; Adlbrecht, Christopher; Cowper, Patricia A; Ray, Linda Davidson; Cohen, Eric A; Lamas, Gervasio A; Hochman, Judith S.
Afiliación
  • Mark DB; Outcomes Research Group, Duke Clinical Research Institute, and the Department of Medicine, Duke University Medical Center, Durham, NC, USA.
N Engl J Med ; 360(8): 774-83, 2009 Feb 19.
Article en En | MEDLINE | ID: mdl-19228620
BACKGROUND: The open-artery hypothesis postulates that late opening of an infarct-related artery after myocardial infarction will improve clinical outcomes. We evaluated the quality-of-life and economic outcomes associated with the use of this strategy. METHODS: We compared percutaneous coronary intervention (PCI) plus stenting with medical therapy alone in high-risk patients in stable condition who had a totally occluded infarct-related artery 3 to 28 days after myocardial infarction. In 951 patients (44% of those eligible), we assessed quality of life by means of a battery of tests that included two principal outcome measures, the Duke Activity Status Index (DASI) (which measures cardiac physical function on a scale from 0 to 58, with higher scores indicating better function) and the Medical Outcomes Study 36-Item Short-Form Mental Health Inventory 5 (which measures psychological well-being). Structured quality-of-life interviews were performed at baseline and at 4, 12, and 24 months. Costs of treatment were assessed for 458 of 469 patients in the United States (98%), and 2-year cost-effectiveness was estimated. RESULTS: At 4 months, the medical-therapy group, as compared with the PCI group, had a clinically marginal decrease of 3.4 points in the DASI score (P=0.007). At 1 and 2 years, the differences were smaller. No significant differences in psychological well-being were observed. For the 469 patients in the United States, cumulative 2-year costs were approximately $7,000 higher in the PCI group (P<0.001), and the quality-adjusted survival was marginally longer in the medical-therapy group. CONCLUSIONS: PCI was associated with a marginal advantage in cardiac physical function at 4 months but not thereafter. At 2 years, medical therapy remained significantly less expensive than routine PCI and was associated with marginally longer quality-adjusted survival. (ClinicalTrials.gov number, NCT00004562.)
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Calidad de Vida / Angioplastia Coronaria con Balón / Estenosis Coronaria / Infarto del Miocardio Tipo de estudio: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2009 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Calidad de Vida / Angioplastia Coronaria con Balón / Estenosis Coronaria / Infarto del Miocardio Tipo de estudio: Clinical_trials / Diagnostic_studies / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2009 Tipo del documento: Article