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International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial.
Ikemura, Nobuhiro; Spertus, John A; Nguyen, Dan; Fu, Zhuxuan; Jones, Philip G; Reynolds, Harmony R; Bangalore, Sripal; Bhargava, Balram; Senior, Roxy; Elghamaz, Ahmed; Goodman, Shaun G; Lopes, Renato D; Pracon, Radoslaw; López-Sendón, José; Maggioni, Aldo P; Kohsaka, Shun; Roth, Gregory A; White, Harvey D; Mavromatis, Kreton; Boden, William E; Rodriguez, Fatima; Hochman, Judith S; Maron, David J.
Afiliación
  • Ikemura N; University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.).
  • Spertus JA; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (N.I., S.K.).
  • Nguyen D; University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.).
  • Fu Z; University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.).
  • Jones PG; University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.).
  • Reynolds HR; University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, (N.I., J.A.S., D.N., Z.F., P.G.J.).
  • Bangalore S; Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (H.R.R., S.B., J.S.H.).
  • Bhargava B; Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (H.R.R., S.B., J.S.H.).
  • Senior R; All India Institute of Medical Sciences, New Delhi (B.B.).
  • Elghamaz A; Northwick Park Hospital, London, United Kingdom (R.S., A.E.).
  • Goodman SG; Northwick Park Hospital, London, United Kingdom (R.S., A.E.).
  • Lopes RD; St Michael's Hospital, University of Toronto, Canada (S.G.G.).
  • Pracon R; Duke Clinical Research Institute, Durham, NC (R.D.L.).
  • López-Sendón J; National Institute of Cardiology, Warsaw, Poland (R.P.).
  • Maggioni AP; IdiPaz Research Institute and Hospital Universitario La Paz, Madrid, Spain (J.L.-S.).
  • Kohsaka S; Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Heart Care Foundation, Florence, Italy (A.P.M.).
  • Roth GA; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (N.I., S.K.).
  • White HD; Division of Cardiology, the University of Washington, Seattle (G.A.R.).
  • Mavromatis K; Health New Zealand Te Whatu Ora, Te Toka Tumal, Green Lane Cardiovascular Services and University of Auckland, New Zealand (H.D.W.).
  • Boden WE; Atlanta VA Medical Center, GA (K.M.).
  • Rodriguez F; Veterans Affairs New England Healthcare System, Boston University School of Medicine, MA (W.E.B.).
  • Hochman JS; Department of Medicine, Stanford University School of Medicine, CA (F.R., D.J.M.).
  • Maron DJ; Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine (H.R.R., S.B., J.S.H.).
Circ Cardiovasc Qual Outcomes ; : e010534, 2024 Sep 20.
Article en En | MEDLINE | ID: mdl-39301726
ABSTRACT

BACKGROUND:

The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.

METHODS:

We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.

RESULTS:

Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points.

CONCLUSIONS:

In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease. REGISTRATION URL https//www.clinicaltrials.gov; Unique identifier NCT01471522.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Circ Cardiovasc Qual Outcomes Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Circ Cardiovasc Qual Outcomes Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos