Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial).
Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial).
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DOI：
10.1016/j.jacc.2011.05.054
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发表时间：
2011-10-04
影响因子：
24
通讯作者：
CREST Investigators
中科院分区：
文献类型：
--
作者：
Cohen DJ;Stolker JM;Wang K;Magnuson EA;Clark WM;Demaerschalk BM;Sam AD Jr;Elmore JR;Weaver FA;Aronow HD;Goldstein LB;Roubin GS;Howard G;Brott TG;CREST Investigators
比较接受颈动脉支架置入术 (CAS) 与颈动脉内膜切除术 (CEA) 治疗的患者的健康相关生活质量 (HRQOL) 结局。在迄今为止最大的颈动脉血运重建随机试验 CREST 中，主要复合终点没有显着差异，但 CAS 和 CEA 之间的卒中和 MI 发生率不同。为了帮助指导个体化临床决策，我们比较了 CREST 中入组患者的 HRQOL。我们还进行了探索性分析，以评估围手术期并发症与 HRQOL 之间的关联。我们测量了 CREST 中随机接受 CAS 或 CEA 的 2502 名患者的基线以及 2 周、1 个月和 1 年后的 HRQOL。 HRQOL 使用医疗结果研究简表 36 (SF-36) 和 6 个疾病特异性量表进行评估，这些量表旨在研究接受颈动脉血运重建的患者的 HRQOL。在 2 周和 1 个月时，CAS 患者在 SF-36 的多个组成部分都有更好的结果，在角色身体功能、疼痛和身体组成部分总结量表方面存在很大差异（全部 p<0.01）。在疾病特异性量表上，CAS 患者报告驾驶、进食/吞咽、颈部疼痛和头痛的困难较少，但行走和腿部疼痛的困难较多（全部 p<0.05）。然而，到 1 年后，CAS 和 CEA 之间的任何 HRQOL 指标都没有差异。在探索性分析中，围手术期卒中与所有 SF-36 领域较差的 1 年 HRQOL 相关，但围手术期心肌梗死或颅神经麻痹则不然。在接受颈动脉血运重建的患者中，与 CEA 相比，CAS 在早期恢复期间与更好的 HRQOL 相关，特别是在身体限制和疼痛方面，但这些差异随着时间的推移而减小，并且在 1 年后并不明显。尽管 CAS 和 CEA 与 1 年时的总体 HRQOL 相关，但特定事件分析证实，卒中对 HRQOL 的影响比 MI 更大、更持久。
To compare health-related quality of life (HRQOL) outcomes in patients treated with carotid artery stenting (CAS) versus carotid endarterectomy (CEA). In CREST, the largest randomized trial of carotid revascularization to date, there was no significant difference in the primary composite endpoint but rates of stroke and MI differed between CAS and CEA. To help guide individualized clinical decision-making, we compared HRQOL among patients enrolled in CREST. We also performed exploratory analyses to evaluate the association between periprocedural complications and HRQOL. We measured HRQOL at baseline, and after 2-weeks, 1-month, and 1-year among 2502 patients randomized to either CAS or CEA in CREST. HRQOL was assessed using the Medical Outcomes Study Short-Form 36 (SF-36) and 6 disease-specific scales designed to study HRQOL in patients undergoing carotid revascularization. At both 2-weeks and 1-month, CAS patients had better outcomes for multiple components of the SF-36, with large differences for role physical function, pain, and the physical component summary scale (all p<0.01). On the disease-specific scales, CAS patients reported less difficulty with driving, eating/swallowing, neck pain, and headaches but more difficulty with walking and leg pain (all p<0.05). However, by 1 year there were no differences in any HRQOL measure between CAS and CEA. In the exploratory analyses, periprocedural stroke was associated with poorer 1-year HRQOL across all SF-36 domains, but periprocedural MI or cranial nerve palsy were not. Among patients undergoing carotid revascularization, CAS is associated with better HRQOL during the early recovery period as compared with CEA—particularly with regard to physical limitations and pain—but these differences diminish over time and are not evident after 1-year. Although CAS and CEA are associated with similar overall HRQOL at 1-year, event-specific analyses confirm that stroke has a greater and more sustained impact on HRQOL than MI.
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DOI：
10.1056/nejmoa0912321
发表时间：
2010-07-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Brott TG;Hobson RW 2nd;Howard G;Roubin GS;Clark WM;Brooks W;Mackey A;Hill MD;Leimgruber PP;Sheffet AJ;Howard VJ;Moore WS;Voeks JH;Hopkins LN;Cutlip DE;Cohen DJ;Popma JJ;Ferguson RD;Cohen SN;Blackshear JL;Silver FL;Mohr JP;Lal BK;Meschia JF;CREST Investigators
通讯作者：
CREST Investigators
影响因子：
48
作者：
Ederle, Joerg;Bonati, Leo H.;Dobson, Joanna;Featherstone, Roland L.;Gaines, Peter A.;Beard, Jonathan D.;Venables, Graham S.;Markus, Hugh S.;Clifton, Andrew;Sandercock, Peter;Brown, Martin M.
通讯作者：
Brown, Martin M.
影响因子：
4.1
作者：
Cunningham, EJ;Bond, R;Rothwell, PM
通讯作者：
Rothwell, PM
影响因子：
24
作者：
Iyer, Sriram S.;White, Christopher J.;Russell, Mary E.
通讯作者：
Russell, Mary E.
影响因子：
11.3
作者：
Stolker, Joshua M.;Mahoney, Elizabeth M.;Cohen, David J.
通讯作者：
Cohen, David J.