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Health Status after...
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Spertus, John A
(författare)
Health Status after Invasive or Conservative Care in Coronary and Advanced Kidney Disease.
- Artikel/kapitelEngelska2020
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LIBRIS-ID:oai:DiVA.org:uu-409545
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-409545URI
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https://doi.org/10.1056/NEJMoa1916374DOI
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Språk:engelska
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Sammanfattning på:engelska
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BACKGROUND: In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status.METHODS: We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy.RESULTS: Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, -0.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, -2.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, -1.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, -2.2 to 3.4).CONCLUSIONS: Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy. (Funded by the National Heart, Lung, and Blood Institute; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).
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Jones, Philip G
(författare)
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Maron, David J
(författare)
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Mark, Daniel B
(författare)
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O'Brien, Sean M
(författare)
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Fleg, Jerome L
(författare)
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Reynolds, Harmony R
(författare)
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Stone, Gregg W
(författare)
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Sidhu, Mandeep S
(författare)
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Chaitman, Bernard R
(författare)
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Chertow, Glenn M
(författare)
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Hochman, Judith S
(författare)
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Bangalore, Sripal
(författare)
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Soveri, Inga,1978-Uppsala universitet,Institutionen för medicinska vetenskaper(författare)
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Held, ClaesUppsala universitet,Uppsala kliniska forskningscentrum (UCR),kardiologi(Swepub:uu)clahe947(författare)
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Uppsala universitetInstitutionen för medicinska vetenskaper
(creator_code:org_t)
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Ingår i:New England Journal of Medicine382:17, s. 1619-16280028-47931533-4406
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Spertus, John A
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Jones, Philip G
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Maron, David J
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Mark, Daniel B
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O'Brien, Sean M
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Fleg, Jerome L
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Reynolds, Harmon ...
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Stone, Gregg W
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Sidhu, Mandeep S
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Chaitman, Bernar ...
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Chertow, Glenn M
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Hochman, Judith ...
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Bangalore, Sripa ...
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Soveri, Inga, 19 ...
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Held, Claes
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