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

David J. Cohen, Joshua M. Stolker, Kaijun Wang, Elizabeth A. Magnuson, Wayne M. Clark, Bart M Demaerschalk, Albert D. Sam, James R. Elmore, Fred A. Weaver, Herbert D. Aronow, Larry B. Goldstein, Gary S. Roubin, George Howard, Thomas G Brott

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

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 CEAparticularly with regard to physical limitations and painbut 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)

Original languageEnglish (US)
Pages (from-to)1557-1565
Number of pages9
JournalJournal of the American College of Cardiology
Volume58
Issue number15
DOIs
StatePublished - Oct 4 2011

Fingerprint

Carotid Endarterectomy
Quality of Life
Carotid Arteries
Stroke
Myocardial Infarction
Mobility Limitation
Cranial Nerve Diseases
Pain
Neck Pain
Deglutition
Headache
Leg
Eating
Outcome Assessment (Health Care)

Keywords

  • carotid endarterectomy
  • carotid stenosis
  • carotid stenting
  • quality of life
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Health-related quality of life after carotid stenting versus carotid endarterectomy : Results from CREST (Carotid Revascularization Endarterectomy versus Stenting Trial). / Cohen, David J.; Stolker, Joshua M.; Wang, Kaijun; Magnuson, Elizabeth A.; Clark, Wayne M.; Demaerschalk, Bart M; Sam, Albert D.; Elmore, James R.; Weaver, Fred A.; Aronow, Herbert D.; Goldstein, Larry B.; Roubin, Gary S.; Howard, George; Brott, Thomas G.

In: Journal of the American College of Cardiology, Vol. 58, No. 15, 04.10.2011, p. 1557-1565.

Research output: Contribution to journalArticle

Cohen, David J. ; Stolker, Joshua M. ; Wang, Kaijun ; Magnuson, Elizabeth A. ; Clark, Wayne M. ; Demaerschalk, Bart M ; Sam, Albert D. ; Elmore, James R. ; Weaver, Fred A. ; Aronow, Herbert D. ; Goldstein, Larry B. ; Roubin, Gary S. ; Howard, George ; Brott, Thomas G. / Health-related quality of life after carotid stenting versus carotid endarterectomy : Results from CREST (Carotid Revascularization Endarterectomy versus Stenting Trial). In: Journal of the American College of Cardiology. 2011 ; Vol. 58, No. 15. pp. 1557-1565.
@article{6135c18798a84f24a6494dff239e3463,
title = "Health-related quality of life after carotid stenting versus carotid endarterectomy: Results from CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)",
abstract = "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 CEAparticularly with regard to physical limitations and painbut 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)",
keywords = "carotid endarterectomy, carotid stenosis, carotid stenting, quality of life, stroke",
author = "Cohen, {David J.} and Stolker, {Joshua M.} and Kaijun Wang and Magnuson, {Elizabeth A.} and Clark, {Wayne M.} and Demaerschalk, {Bart M} and Sam, {Albert D.} and Elmore, {James R.} and Weaver, {Fred A.} and Aronow, {Herbert D.} and Goldstein, {Larry B.} and Roubin, {Gary S.} and George Howard and Brott, {Thomas G}",
year = "2011",
month = "10",
day = "4",
doi = "10.1016/j.jacc.2011.05.054",
language = "English (US)",
volume = "58",
pages = "1557--1565",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "15",

}

TY - JOUR

T1 - Health-related quality of life after carotid stenting versus carotid endarterectomy

T2 - Results from CREST (Carotid Revascularization Endarterectomy versus Stenting Trial)

AU - Cohen, David J.

AU - Stolker, Joshua M.

AU - Wang, Kaijun

AU - Magnuson, Elizabeth A.

AU - Clark, Wayne M.

AU - Demaerschalk, Bart M

AU - Sam, Albert D.

AU - Elmore, James R.

AU - Weaver, Fred A.

AU - Aronow, Herbert D.

AU - Goldstein, Larry B.

AU - Roubin, Gary S.

AU - Howard, George

AU - Brott, Thomas G

PY - 2011/10/4

Y1 - 2011/10/4

N2 - 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 CEAparticularly with regard to physical limitations and painbut 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)

AB - 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 CEAparticularly with regard to physical limitations and painbut 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)

KW - carotid endarterectomy

KW - carotid stenosis

KW - carotid stenting

KW - quality of life

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=80053314827&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053314827&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2011.05.054

DO - 10.1016/j.jacc.2011.05.054

M3 - Article

C2 - 21958882

AN - SCOPUS:80053314827

VL - 58

SP - 1557

EP - 1565

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 15

ER -