Publications [#197803] of Daniel B. Mark

Papers Published

1. DB Mark, W Pan, NE Clapp-Channing, KJ Anstrom, JR Ross, RS Fox, GP Devlin, CE Martin, C Adlbrecht, PA Cowper, LD Ray, EA Cohen, GA Lamas, JS Hochman, Occluded Artery Trial Investigators, Quality of life after late invasive therapy for occluded arteries., The New England journal of medicine, vol. 360 no. 8 (February, 2009), pp. 774-83, ISSN 1533-4406 [doi]
   (last updated on 2011/11/29)

   Abstract:
   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.)

   Keywords:
   Activities of Daily Living • Aged • Angina Pectoris • Angioplasty, Balloon, Coronary* • Combined Modality Therapy • Coronary Stenosis • Cost-Benefit Analysis • Female • Follow-Up Studies • Humans • Male • Middle Aged • Myocardial Infarction • Quality of Life* • Quality-Adjusted Life Years • Regression Analysis • Stents • Treatment Outcome • drug therapy* • economics • epidemiology • physiopathology • psychology • therapy*