Quality of Life after Late Invasive Therapy for Occluded Arteries

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.).