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CLINICAL STUDY

Quality of life after balloon angioplasty or stenting for acute myocardial infarction

One-year results from the Stent-PAMI trial

Stéphane Rinfret, MD, MSc, FRCP(C)^* , Cindy L. Grines, MD, FACC, Roberta S. Cosgrove, MSc, MPH^*, Kalon K. L. Ho, MD, MSc, FACC^* , David A. Cox, MD, FACC^||, Bruce R. Brodie, MD, FACC^¶, Marie-Claude Morice, MD, FACC^#, Gregg W. Stone, MD, FACC^**, David J. Cohen, MD, MSc^*,* the Stent-PAMI Investigators

^* Cardiovascular Data Analysis Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
^|| Mid Carolina Cardiology, Charlotte, North Carolina, USA
^¶ LeBauer Health Care, Greensboro, North Carolina, USA
^# Institut Cardiovasculaire Paris Sud, Antony, France
^** Lenox Hill Hospital, New York, New York, USA

Manuscript received March 7, 2001; revised manuscript received July 13, 2001, accepted August 9, 2001.

^* Reprint requests and correspondence: Dr. David J. Cohen, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215 USA
djc{at}hsph.harvard.edu

OBJECTIVES

The goal of this study was to compare the impact of primary stenting or percutaneous transluminal coronary angioplasty (PTCA) on health-related quality of life (HRQOL) in patients undergoing direct angioplasty for acute myocardial infarction (AMI).

BACKGROUND

Previous studies have demonstrated that coronary stenting reduces clinical and angiographic restenosis compared with PTCA. However, the impact of stenting on HRQOL from the patient’s perspective remains unknown.

METHODS

We administered the Seattle Angina Questionnaire and the Medical Outcomes Study Short-form Survey at 1, 6 and 12 months after initial treatment to all North American patients in the Stent-Primary Angioplasty for Myocardial Infarction trial (Stent-PAMI) (n = 509)—a randomized trial comparing primary stenting to conventional PTCA for patients with AMI.

RESULTS

At one month, most HRQOL measures were similar for the two groups, but stent patients reported less bodily pain than PTCA patients (p = 0.03). At six-month follow-up, stenting resulted in significant improvements in several dimensions of HRQOL including reduced anginal frequency and bodily pain as well as improved disease perception (all p 0.03) and a trend towards better anginal stability (p = 0.056). By 12-month follow-up, however, none of these differences remained statistically significant. These differences in HRQOL were largely explained by the greater need for ischemia-driven target-vessel repeat revascularization procedures in PTCA patients during the first six months (16.0% vs. 6.2%, p < 0.001).

CONCLUSIONS

In patients undergoing revascularization for AMI, initial stent placement is associated with improvements in several dimensions of health status during the first six months of follow-up. In the absence of differences in mortality, these findings add to the overall argument in favor of initial stenting in patients treated with mechanical reperfusion for myocardial infarction.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   CCS = Canadian Cardiovascular Society   COPD = chronic obstructive pulmonary disease   HRQOL = health-related quality of life   MI = myocardial infarction   OPUS = Optimum PTCA compared with Routine Stent Strategy trial   PCI = percutaneous coronary intervention   PTCA = percutaneous transluminal coronary angioplasty   QOL = quality of life   SAQ = Seattle Angina Questionnaire   SF-36 = Medical Outcomes Study (MOS) Short-form Survey   Stent-PAMI = Stent-Primary Angioplasty for Myocardial Infarction trial   TVR = target-vessel revascularization

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