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MedPageToday.com
Published: Jul 7, 2014
By Todd Neale, Senior Staff Writer, MedPage Today
A new TACT analysis showed that chelation therapy did not enhance quality of life in patients recovering from a heart attack. Also, very late stent thrombosis does not appear to be a major issue with newer drug-eluting stents.
Chelation Fails to Improve Quality of Life After MI
Chelation therapy did not improve quality of life in patients with stable coronary disease who were at least 6 months into their recovery from a myocardial infarction, an analysis of the TACT trial showed.
The main trial results — presented for the first time in 2012 — showed that a disodium EDTA chelation regimen significantly reduced the rate of mortality, recurrent MI, stroke, coronary revascularization, or hospitalization for angina relative to placebo (26% versus 30%; HR 0.82, 95% CI 0.69-0.99), a finding that was not welcomed by most cardiologists.
In a subset analysis of 911 patients — reported online in Circulation: Cardiovascular Quality and Outcomes —researchers led by Daniel Mark, MD, MPH, of the Duke Clinical Research Institute, examined the effects on quality of life through 2 years of follow-up. The primary quality-of-life measures were the Duke Activity Status Index (DASI) — which measures cardiac-related functional status — and the Short-Form 36 Mental Health Inventory-5 (MHI-5) — which measures psychological distress.
Baseline quality of life was similar in the chelation and placebo groups. In the first 6 months of treatment, DASI scores improved in both groups, with no evidence of a difference according to treatment. The finding was similar for the MHI-5 and some secondary quality-of-life measures.
Mark and colleagues offered two possible explanations for the lack of quality-of-life improvements with chelation therapy. First, it is possible that chelation “alters aspects of coronary artery disease progression that do not have symptomatic correlates.” And second, it is possible that the patients had such a low burden of cardiac symptoms at baseline that there was little room for improvement.
The latter possibility “suggests that the effectiveness of this form of therapy to improve symptoms and functioning in patients with chronic cardiac symptoms will require additional study,” the authors wrote.