Clinical research
Coronary artery disease
Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non–ST-segment elevation myocardial infarction: One-year results of the third randomized intervention trial of unstable angina (RITA-3)

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Objectives

We sought to compare the effects of an early interventional strategy (IS) versus a conservative strategy (CS) on health-related quality of life (HRQOL) in patients with non–ST-segment elevation acute coronary syndromes (ACS).

Background

The third Randomized Intervention Trial of unstable Angina (RITA-3) evaluated early IS (n = 895) versus CS (n = 915). We report one-year results of the RITA-3 trial concerning HRQOL.

Methods

The patients' HRQOL was assessed with the Short Form-36 (SF-36) and Seattle Angina Questionnaire (SAQ) at four-month and one-year follow-up, and the EuroQOL Visual Analogue Scale (EQ-VAS) and EuroQOL 5-Dimensional Classification (EQ-5D) also measured at baseline. Analysis was performed using the two-sample ttest and analysis of co-variance.

Results

Mean changes from baseline EQ-VAS scores were better for IS than for CS at four months (treatment difference of 3.0, p < 0.001) and one year (2.3, p < 0.01). The EQ-5D utility scores were also higher for IS at four months (treatment difference: 0.036, p < 0.01) and at one year (0.016, p = 0.20). For SF-36, IS scored significantly better at four months for physical function, physical role function, emotional role function, social function, vitality, and general health. The SAQ scores for exertional capacity, anginal stability and frequency, treatment satisfaction, and disease perception were better for IS at four months. These treatment differences were present but attenuated by one-year follow-up. Improvements in HRQOL for IS could be attributed to improvements in anginal symptoms.

Conclusions

In patients with non–ST-segment elevation ACS, an early IS provides greater gains in HRQOL, as compared with CS, mainly due to improvements in angina grade.

Abbreviations and acronyms

ACS
acute coronary syndrome
CS
conservative strategy
CCS
Canadian Cardiovascular Society
HRQOL
health-related quality of life
IS
interventional strategy
EQ-5D
EuroQOL 5-Dimensional Classification
EQ-VAS
EuroQOL Visual Analogue Scale
MI
myocardial infarction
RITA-3
third Randomized Intervention Trial of unstable Angina
SAQ
Seattle Angina Questionnaire
SF-36
Short Form-36

Cited by (0)

RITA-3 was funded by a competitive grant from the British Heart Foundation (London), and the British Heart Foundation received a donation from Aventis Pharma (Strasbourg, France). Additional governmental support (Culyer) was obtained to partially reimburse interventional center costs of percutaneous coronary intervention catheters and stents. The authors have no conflicts of interest with respect to the RITA-3 trial. However, Dr. Henderson has received honoraria from Schering Plough, as well as travel grants from Boston Scientific and Medtronic AVE. Dr. Fox or his institution has received unrestricted grant funding and/or honoraria from Bristol Myers Squibb, Sanofi-Synthelabo, Aventis, Merck, and Bayer.