Quality of Life after Late Invasive Therapy for Occluded Arteries
Key result
Percutaneous coronary intervention plus stenting provided a marginal 3.4-point advantage in DASI score at 4 months compared to medical therapy alone (P=0.007), with no difference at 2 years.
Why the study?
Does PCI plus stenting improve quality of life and cost-effectiveness compared to medical therapy alone in stable high-risk patients with a totally occluded infarct-related artery 3 to 28 days after myocardial infarction?
Population
951 high-risk patients in stable condition who had a totally occluded infarct-related artery 3 to 28 days…
Comparison
Percutaneous coronary intervention plus stenting vs Medical therapy alone
Design
RCT
Follow-up
24 months
Authors
Discussion
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Implication
Late PCI yields only transient marginal QoL gains at higher cost; challenges routine use in stable post-MI occluded arteries.
Study Design
Type
RCT (n=951)
Multicenter
Yes
Structured PICO
Does PCI plus stenting improve quality of life and cost-effectiveness compared to medical therapy alone in stable high-risk patients with a totally occluded infarct-related artery 3 to 28 days after myocardial infarction?
P
Population
951 high-risk stable patients with a totally occluded infarct-related artery 3 to 28 days post-myocardial infarction, followed for 24 months.
I
Intervention
Percutaneous coronary intervention (PCI) plus stenting
C
Comparator
Medical therapy alone
O
Outcome
Quality of life assessed by the Duke Activity Status Index (DASI) and the Medical Outcomes Study 36-Item Short-Form Mental Health Inventory 5 at 4, 12, and 24 monthspatient reported
Main Result
Mean Difference: 3.4
p-value: p=0.007
Late PCI for an occluded infarct-related artery provides only a marginal, transient quality-of-life benefit over medical therapy while significantly increasing costs.
Cite This Study
Mark et al. (2009) conducted an RCT in Myocardial infarction with totally occluded infarct-related artery (n=951). Percutaneous coronary intervention (PCI) plus stenting vs. Medical therapy alone was evaluated on Duke Activity Status Index (DASI) score at 4 months (MD 3.4, p=0.007). Percutaneous coronary intervention plus stenting provided a marginal 3.4-point advantage in DASI score at 4 months compared to medical therapy alone (P=0.007), with no difference at 2 years.