Quality of life after balloon angioplasty or stenting for acute myocardialinfarction

OBJECTIVES The goal of this study was to compare the impact of primary sten ting or percutaneous transluminal coronary angioplasty (PTCA) on health-rel ated quality of life (HRQOL) in patients undergoing direct angioplasty for acute myocardial infarction (AMI). BACKGROUND Previous studies have demonstrated that coronary stenting reduce s clinical and angiographic restenosis compared with PTCA. However, the imp act of stenting on HRQOL from the patient's perspective remains unknown. METHODS We administered the Seattle Angina Questionnaire and the Medical Ou tcomes Study Short-form Survey at 1, 6 and 12 months after initial treatmen t to all North American patients in the Stent-Primary Angioplasty for Myoca rdial 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 s everal dimensions of HRQOL including reduced anginal frequency and bodily p ain as well as improved disease perception (all p less than or equal to 0.0 3) and a trend towards better anginal stability (p = 0.056). By 12-month fo llow-up, however, none of these differences remained statistically signific ant. These differences in HRQOL were largely explained by the greater need for ischemia-driven target-vessel repeat revascularization procedures in PT CA 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 differen ces in mortality, these findings add to the overall argument in favor of in itial stenting in patients treated with mechanical reperfusion for myocardi al infarction. (C) 2001 by the American College of Cardiology.