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Louise Pilote, MD, MPH, PhD; Claude Lauzon, MD; Thao Huynh, MD; Danielle Dion, MD; René Roux, MD; Normand Racine, MD; Suzanne Carignan, MD; Jean G. Diodati, MD; Claude Lévesque, MD; François Charbonneau, MD; Joël Pouliot, MD; Lawrence Joseph, PhD; Mark J. Eisenberg, MD, MPH

Arch Intern Med. 2002;162:553-559.

Background  Previous studies have compared the treatment and outcome of patients with acute myocardial infarction (AMI) admitted at sites with and without availability of angiography. Although mortality rates do not differ, it is unknown if quality of life (QOL) and functional status differ.

Methods  We measured QOL and functional status in patients with AMI treated within Québec at 5 sites with (n = 253) and 5 sites without (n = 334) angiography.

Results  At admission, clinical characteristics, complication rates, and baseline measures of QOL and functional status were similar at sites with and without angiography. During hospitalization, patients treated at sites with angiography were more likely to undergo an invasive cardiac procedure than patients admitted at sites without angiography (angiography, 63% vs 26%; percutaneous transluminal coronary angioplasty, 33% vs 13%; and coronary artery bypass graft, 12% vs 5%). At 30 days and 6 months after AMI, QOL was slightly superior at sites with angiography, but by 1 year, most measures of QOL were back to baseline at both types of sites and were similar between the 2 groups. At 6 months, most standard health-related QOL components were similar; only physical and emotional role limitations were higher at sites with angiography. Return to work occurred earlier (at 30 days, 23% vs 12%), and a lower proportion of patients was readmitted for angina (within 1 year after AMI, 12% vs 18%) at sites with angiography.

Conclusions  In the early post-AMI period, the QOL of patients admitted at sites with angiography was higher than that of patients admitted at sites without angiography. However, by 1 year, the QOL and functional status of patients was similar in both groups. Differences in QOL were greatest when differences in treatment were greatest, lending support to a positive albeit small association between an early invasive approach to post-AMI care and improved QOL.

From McGill University Health Centre (Drs Pilote, Huynh, Charbonneau, and Joseph); Centre Hospitalier de la Région de l'Amiante (Dr Lauzon); Centre Hospitalier Beauce Etchemin (Dr Dion); Hôpital Sainte-Croix de Drummondville (Dr Roux); Université de Montréal (Drs Racine and Diodati); Centre Hospitalier régional du Grand Portage (Dr Carignan); Complèxe Hospitalier de La Sagamie (Dr Lévesque); Centre Hospitalier de Val D'or (Dr Pouliot); and Jewish General Hospital (Dr Eisenberg), Montreal, Québec.

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