University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
J Am Coll Cardiol. 2024 Apr 16;83(15):1353-1366. doi: 10.1016/j.jacc.2024.02.019.
The ISCHEMIA trial found that patients with chronic coronary disease randomized to invasive strategy had better health status than those randomized to conservative strategy. It is unclear how best to translate these population-level results to individual patients.
The authors sought to identify patient characteristics associated with health status from invasive and conservative strategies, and develop a prediction algorithm for shared decision-making.
One-year disease-specific health status was assessed in ISCHEMIA with the Seattle Angina Questionnaire (SAQ) Summary Score (SAQ SS) and Angina Frequency, Physical Limitations (PL), and Quality of Life (QL) domains (range 0-100, higher = less angina/better health status).
Among 4,617 patients from 320 sites in 37 countries, mean SAQ SS was 74.1 ± 18.9 at baseline and 85.7 ± 15.6 at 1 year. Lower baseline SAQ SS and younger age were associated with better 1-year health status with invasive strategy (P interaction = 0.009 and P interaction = 0.004, respectively). For the individual domains, there were significant treatment interactions for baseline SAQ score (Angina Frequency, PL), age (PL, QL), anterior ischemia (PL), and number of baseline antianginal medications (QL), with more benefit of invasive in patients with worse baseline health status, younger age, anterior ischemia, and on more antianginal medications. Parsimonious prediction models were developed for 1-year SAQ domains with invasive or conservative strategies to support shared decision-making.
In the management of chronic coronary disease, individual patient characteristics are associated with 1-year health status, with younger age and poorer angina-related health status showing greater benefit from invasive management. This prediction algorithm can support the translation of the ISCHEMIA trial results to individual patients. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).
ISCHEMIA 试验发现，患有慢性冠状动脉疾病的患者随机分为介入策略组的健康状况优于随机分为保守策略组的患者。目前尚不清楚如何将这些人群水平的结果最好地转化为个体患者。
作者试图确定与介入和保守策略相关的健康状况的患者特征，并开发用于共同决策的预测算法。
使用西雅图心绞痛问卷（SAQ）综合评分（SAQ SS）和心绞痛频率、体力限制（PL）和生活质量（QL）领域评估 ISCHEMIA 中 1 年的特定疾病健康状况（范围 0-100，越高表示心绞痛越少/健康状况越好）。
在来自 37 个国家的 320 个地点的 4617 名患者中，基线时 SAQ SS 的平均值为 74.1±18.9，1 年后为 85.7±15.6。较低的基线 SAQ SS 和较年轻的年龄与介入策略的 1 年健康状况更好相关（P 交互=0.009 和 P 交互=0.004）。对于个体领域，基线 SAQ 评分（心绞痛频率、PL）、年龄（PL、QL）、前壁缺血（PL）和基线抗心绞痛药物数量（QL）存在显著的治疗交互作用，介入策略在基线健康状况较差、年龄较小、前壁缺血和使用更多抗心绞痛药物的患者中获益更多。为支持共同决策，针对介入或保守策略制定了 1 年 SAQ 领域的简约预测模型。
在慢性冠状动脉疾病的治疗中，个体患者特征与 1 年健康状况相关，年龄较小和心绞痛相关健康状况较差的患者从介入治疗中获益更大。该预测算法可以支持将 ISCHEMIA 试验结果转化为个体患者。（国际比较医疗和介入方法有效性研究 [ISCHEMIA]；NCT01471522）。
