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

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.