Angina frequency after myocardial infarction and quality of life in older versus younger adults: the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery study.

BACKGROUND: Residual angina is known to be strongly associated with health-related quality of life (HRQL) in patients with chronic coronary artery disease. As the age of myocardial infarction (MI) survivors increases, better insights into the relationship between angina frequency and HRQL in older as compared to younger patients are needed to efficiently target medical resources. METHODS: We evaluated angina frequency and HRQL at 1 and 6 months after MI in 1,795 post-MI survivors using the Seattle Angina Questionnaire (SAQ). We compared changes in HRQL between older (age ≥70 years, n = 464) and younger (age <70 years, n = 1,331) patients as a function of change in SAQ angina frequency scores using hierarchical linear modeling within site. RESULTS: After adjusting for baseline HRQL and 26 other covariates, older patients with similar or improved angina control at 6 months had significantly greater improvements in HRQL than younger patients (difference in SAQ quality-of-life scale 8.77 points [CI 4.00-13.54, P = .0003] and 2.56 points [CI 0.66-4.47, P = .0084], respectively). However, older patients with increased angina experienced similar declines in HRQL as compared to younger patients. CONCLUSION: In stable patients with coronary artery disease after a recent MI, changes in angina control were correlated with HRQL in both older and younger patients. However, improved angina control was associated with greater HRQL improvements in older than in younger adults, underscoring the importance of aggressive angina control in older patients.

Clinical referral patterns for carotid artery stenting versus carotid endarterectomy: results from the Carotid Artery Revascularization and Endarterectomy Registry.

BACKGROUND: Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. Although randomized clinical trials are the gold standard for assessing the relative benefits of different treatments, observational research is necessary for determining "real-world" effectiveness. Current recommendations limit the application of CAS to high-risk patients, undermining the ability to "balance" the characteristics of patients treated with either approach. We compared the clinical profiles of patients referred for CAS versus CEA in a large national database. METHODS AND RESULTS: Clinical characteristics of 12 701 patients referred for CAS or CEA in the National Cardiovascular Data Registry-Carotid Artery Revascularization and Endarterectomy were compared for 44 clinical and demographic variables. To investigate the comparability of CAS and CEA patients, we stratified the cohort into quintiles of the propensity score for referral for CAS. Among 8069 patients referred for CAS and 4632 referred for CEA, the CAS patients had significantly more comorbidities. Whereas the propensity model balanced most covariates, the pooled standardized differences (≥10%) suggested persistent imbalance for ischemic heart disease, recent myocardial infarction, and restenosis of prior CAS/CEA, all of which were more common in the CAS group. After stratification of propensity scores by quintile, CEA patients comprised only 14% of the upper 2 quintiles. CONCLUSIONS: Characteristics of patients referred for CAS differ markedly from those referred for CEA. Because of extreme clinical disparities between these patients, generalizable comparative effectiveness analyses of observational data will be difficult.