September 25, 2011
Substudy of CREST Compares CAS and CEA Quality-of-Life Results
September 26, 2011—In the Journal of the American College of Cardiology, David J. Cohen, MD, et al published findings from a study that sought to compare health-related quality-of-life (HRQOL) outcomes in patients who were treated with carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in CREST (the Carotid Revascularization Endarterectomy Versus Stenting Trial) (2011;58:1557–1565).
The investigators noted that in CREST, the largest randomized trial of carotid revascularization to date, there was no significant difference in the primary composite endpoint; however, rates of stroke and myocardial infarction (MI) differed between CAS and CEA. In this substudy, the investigators compared HRQOL among patients enrolled in the CREST study to help guide individualized clinical decision making. They also performed exploratory analyses to evaluate the association between periprocedural complications and HRQOL.
As detailed in the Journal of the American College of Cardiology, the investigators measured HRQOL at baseline, 2 weeks, 1 month, and 1 year after treatment among 2,502 patients who were randomly assigned to either CAS or CEA in the CREST study. They assessed HRQOL using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and six disease-specific scales designed to study HRQOL in patients undergoing carotid revascularization.
The investigators found that 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 < .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 < .05). However, at 1 year, there were no differences in any of the HRQOL measures 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.
The investigators concluded that 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 than MI on HRQOL.