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Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial).

Publication ,  Journal Article
Cohen, DJ; Stolker, JM; Wang, K; Magnuson, EA; Clark, WM; Demaerschalk, BM; Sam, AD; Elmore, JR; Weaver, FA; Aronow, HD; Goldstein, LB ...
Published in: J Am Coll Cardiol
October 4, 2011

OBJECTIVES: The purpose of this study was to compare health-related quality of life (HRQOL) outcomes in patients treated with carotid artery stenting (CAS) versus carotid endarterectomy (CEA). BACKGROUND: In CREST (Carotid Revascularization Endarterectomy versus Stenting Trial), the largest randomized trial of carotid revascularization to date, there was no significant difference in the primary composite endpoint, but rates of stroke and myocardial infarction (MI) differed between CAS and CEA. To help guide individualized clinical decision making, we compared HRQOL among patients enrolled in the CREST study. We also performed exploratory analyses to evaluate the association between periprocedural complications and HRQOL. METHODS: We measured HRQOL at baseline, and after 2 weeks, 1 month, and 1 year among 2,502 patients randomly assigned to either CAS or CEA in the CREST study. The 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. RESULTS: 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. CONCLUSIONS: 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. (Carotid Revascularization Endarterectomy versus Stenting Trial [CREST]; NCT00004732)

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 4, 2011

Volume

58

Issue

15

Start / End Page

1557 / 1565

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stents
  • Quality of Life
  • Middle Aged
  • Male
  • Humans
  • Female
  • Endarterectomy, Carotid
  • Carotid Stenosis
  • Cardiovascular System & Hematology
 

Citation

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Cohen, D. J., Stolker, J. M., Wang, K., Magnuson, E. A., Clark, W. M., Demaerschalk, B. M., … CREST Investigators, . (2011). Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol, 58(15), 1557–1565. https://doi.org/10.1016/j.jacc.2011.05.054
Cohen, David J., Joshua M. Stolker, Kaijun Wang, Elizabeth A. Magnuson, Wayne M. Clark, Bart M. Demaerschalk, Albert D. Sam, et al. “Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial).J Am Coll Cardiol 58, no. 15 (October 4, 2011): 1557–65. https://doi.org/10.1016/j.jacc.2011.05.054.
Cohen DJ, Stolker JM, Wang K, Magnuson EA, Clark WM, Demaerschalk BM, et al. Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol. 2011 Oct 4;58(15):1557–65.
Cohen, David J., et al. “Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial).J Am Coll Cardiol, vol. 58, no. 15, Oct. 2011, pp. 1557–65. Pubmed, doi:10.1016/j.jacc.2011.05.054.
Cohen DJ, Stolker JM, Wang K, Magnuson EA, Clark WM, Demaerschalk BM, Sam AD, Elmore JR, Weaver FA, Aronow HD, Goldstein LB, Roubin GS, Howard G, Brott TG, CREST Investigators. Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol. 2011 Oct 4;58(15):1557–1565.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 4, 2011

Volume

58

Issue

15

Start / End Page

1557 / 1565

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stents
  • Quality of Life
  • Middle Aged
  • Male
  • Humans
  • Female
  • Endarterectomy, Carotid
  • Carotid Stenosis
  • Cardiovascular System & Hematology