| Title: |
International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial. |
| Authors: |
Nobuhiro Ikemura1,2,3 ikemu0129@gmail.com; Spertus, John A.1,2; Dan Nguyen1,2; Zhuxuan Fu1,2; Jones, Philip G.1,2; Reynolds, Harmony R.4; Bangalore, Sripal4; Bhargava, Balram5; Senior, Roxy6; Elghamaz, Ahmed6; Goodman, Shaun G.7; Lopes, Renato D.8; Pracoñ, Radoslaw9; López-Sendón, José10; Maggioni, Aldo P.11; Kohsaka, Shun3; Roth, Gregory A.12; White, Harvey D.13,14; Mavromatis, Kreton15; Boden, William E.16 |
| Source: |
Circulation: Cardiovascular Quality & Outcomes. Oct2024, Vol. 17 Issue 10, p909-921. 13p. |
| Abstract: |
BACKGROUND The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results. METHODS: We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions. RESULTS: Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was |
| Database: |
Supplemental Index |