Functional status and quality of life following non-Q wave myocardial infarction

OBJECTIVE: To review the literature on the management of non-Q wave myocardial infarction (NQWMI) with regard to functional status and quality of life outcomes. BACKGROUND: Recent trials have raised the question of whether all patients with NQWMI should undergo an early routine invasive investigation versus a noninvasive ischemia-driven approach. Previous studies examined the management of NQWMI and focused on mortality and recurrent myocardial infarctions. Little is known about whether a routine invasive approach affects functional status and quality of life. METHODS: A MEDLINE search of the English-language literature from 1981 to 2001 was performed using the terms myocardial infarction, NQWMI, risk stratification, prognosis and management. This search was supplemented by narrowed searches of subheadings and surveys of references cited in review articles and book chapters. Emphasis was placed on those studies that included information on the outcomes of quality of life and functional status. RESULTS: Earlier studies suggest that there is little benefit to a routine invasive strategy. These studies demonstrated an increase in mortality and periprocedural complications. In older studies there is some evidence that suggests routine revascularization improves the secondary end points of quality of life, functional status and patient satisfaction. Two recent trials have suggested that with newer technology, including stenting and the use of antithrombotic and antiplatelet agents, there may be a mortality advantage to a routine invasive approach. Substantial functional status and quality of life advantages to this strategy are possible and expected, but little data exists to support this in the literature. CONCLUSION: The optimal strategy for the management of patients with NQWMI is still unclear despite recent studies suggesting improved outcomes with a routine invasive strategy. There is a growing body of literature on the impact of therapy on functional status and quality of life in many disciplines. The impact of routine revascularization on functional status and quality of life requires evaluation in specific, randomized, controlled trials.