Association Between Myocardial Infarction and Quality of Life in the ISCHEMIA Trial

Mario Gaudino; Gregg W Stone; Rachel S Heise; Tulio Caldonazo; Jessica Kim; Lamia Harik; Sigrid Sandner; Giuseppe Biondi-Zoccai; Ruth Masterson-Creber; John H Alexander; Deepak L Bhatt; John Puskas; P J Devereaux; John Spertus; Bjorn Redfors

doi:10.1016/j.jcin.2025.02.011

Association Between Myocardial Infarction and Quality of Life in the ISCHEMIA Trial

JACC Cardiovasc Interv. 2025 May 26;18(10):1263-1272. doi: 10.1016/j.jcin.2025.02.011. Epub 2025 Apr 23.

Authors

Affiliations

¹ Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA. Electronic address: mfg9004@med.cornell.edu.
² Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Division of Biostatisticcs, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.
⁴ Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
⁵ Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
⁶ Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
⁷ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy.
⁸ Columbia University School of Nursing, New York, New York, USA.
⁹ Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, North Carolina, USA.
¹⁰ Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai Cardiovascular Institute, New York, New York, USA; Department of Cardiovascular Surgery, Mount Sinai Heart at Mount Sinai Beth Israel, New York, New York, USA.
¹² Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹³ University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri, USA.
¹⁴ Division of Biostatisticcs, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 40272347
DOI: 10.1016/j.jcin.2025.02.011

Abstract

Background: The association between myocardial infarction (MI) subtypes (procedural MI [PMI] and spontaneous MI [SMI]) and subsequent quality of life (QoL) is incompletely understood.

Objectives: The authors analyzed the association between PMI and SMI and generic and disease-specific QoL in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial.

Methods: QoL was assessed before randomization and at 1.5, 3, and 6 months, and every 6 months thereafter. European Quality of Life-5 dimensions visual analog scale (EQ-5D VAS) (generic) and Seattle Angina Questionnaire (SAQ-7) summary score (disease-specific) were used. The primary analysis was a linear, repeated-measures, multivariable-adjusted, mixed-effects model, with a random intercept for patient. QoL assessments occurring <3 months after MI were defined as early QoL and those occurring >3 months after MI were defined as late QoL.

Results: A total of 4,375 randomized patients were included in the primary analysis population. The median duration of follow-up was 36.2 months (Q1-Q3: 23.8-49.5 months). In the primary analysis population, a total of 84 PMIs and 352 SMIs occurred. SMI was associated with significant decreases in both early (adjusted difference -5.7; 95% CI: -7.3 to -4.1 points) and late EQ-5D VAS (-3.1 points; 95% CI: -4.3 to -1.9 points) and in early (-7.7 points; 95% CI: -9.4 to -6.1 points) and late SAQ-7 (-1.9 points; 95% CI: -3.2 to -0.7 points). PMI was not associated with early (adjusted difference -0.8 points; 95% CI: -3.3 to 1.8 points) or late (-0.7 points; 95% CI: -2.7 to 1.2 points) changes in EQ-5D VAS, and was associated with a reduction in early (-3.0 points; 95% CI: -5.7 to -0.4) but not late SAQ-7 (-0.2 points; 95% CI -2.2 to 1.8 points).

Conclusions: In ISCHEMIA, SMI was associated with reductions in both early and late generic and disease-specific QoL, whereas PMI was only associated with a transient reduction in disease-specific QoL.

Keywords: coronary artery disease; myocardial infarction; quality of life.

Publication types

Randomized Controlled Trial
Multicenter Study

MeSH terms

Aged
Female
Health Status
Humans
Male
Middle Aged
Myocardial Infarction* / diagnosis
Myocardial Infarction* / physiopathology
Myocardial Infarction* / psychology
Myocardial Infarction* / therapy
Non-ST Elevated Myocardial Infarction* / diagnosis
Non-ST Elevated Myocardial Infarction* / psychology
Non-ST Elevated Myocardial Infarction* / therapy
Percutaneous Coronary Intervention* / adverse effects
Quality of Life*
Risk Factors
ST Elevation Myocardial Infarction* / diagnosis
ST Elevation Myocardial Infarction* / psychology
ST Elevation Myocardial Infarction* / therapy
Surveys and Questionnaires
Time Factors
Treatment Outcome