Clinical Investigations
Outcomes, Health Policy, and Managed Care
Health-related quality of life and long-term mortality in patients treated with percutaneous coronary intervention

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Background

Health status has become increasingly important as an outcome measure in patients with cardiovascular disease. Poor patient-rated health status has been shown to predict mortality in patients with coronary artery disease and heart failure. In patients treated with percutaneous coronary intervention (PCI), we examined whether poor health status predicts 6-year mortality and whether a decline in health status is associated with adverse clinical outcome.

Methods

Consecutive patients (N = 872) treated with PCI as part of the RESEARCH registry, completed the 36-item Short-Form Health Survey (SF-36) at 1 and 12 months post-PCI.

Results

The SF-36 domains physical functioning (hazard ratio [HR] 2.59, 95% CI 1.61-4.16), social functioning (HR 2.76, 95% CI 1.74-4.37), role limitations due to physical functioning (HR 2.45, CI 1.52-3.92), mental health (HR 2.12, 95% CI 1.35-3.31), vitality (HR 1.73, 95% CI 1.09-2.74), bodily pain (HR 2.25, 95% CI 1.43-3.54), and general health (HR 2.46, 95% CI 1.57-3.87) were associated with 6-year mortality. A decline in health status was not related with higher 6-year mortality.

Conclusions

Health status domains as measured with the SF-36 predicted death at 6-year follow-up in PCI patients treated with drug-eluting stenting, independent of demographic and clinical characteristics. In contrast, a decline in health status between 1 and 12 months post index procedure, as measured with the SF-36, was not associated with 6-year mortality in PCI patients treated with drug-eluting stenting.

Section snippets

Study population

The initial study population included 875 consecutive patients (response rate = 71%) treated with PCI with either sirolimus-eluting stents (SESs) or bare metal stent implantation between October 16, 2001, and October 15, 2002, as part of the RESEARCH registry who participated in the psychological substudy.9 The design of the RESEARCH registry has been published elsewhere.10 Briefly, the RESEARCH registry is a single-center registry evaluating the safety and efficacy of SES implantation in

Baseline characteristics

Patient baseline characteristics for the total sample at 6-year follow-up are presented in Table I. Mean age in the population was 62 years and 72% were men. There were 96 deaths during the 6-year follow-up period. The average follow-up time was 6.0 years (range 4-7 years).

Nonresponders on the SF-36 at 1 or 12 months were similar divided as compared with responders on most clinical baseline characteristics. Only more previous PCI was present in the nonresponders (32% vs 23%, P = .03).

Poor health status as predictor of 6-year mortality

The

Discussion

In the current study, we found that poor health status, as measured with the SF-36, is a strong, independent predictor of 6-year mortality in PCI patients treated in the drug-eluting stent era, with the associated adjusted HRs ranging from 1.73 to 2.76. In contrast, we did not find any relation between a decline in health status between 1 and 12 months and mortality at 6 years.

Several other studies have shown that poor health status predicts adverse clinical outcome in patients with heart

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