Quality-of-life outcomes with a disodium EDTA chelation regimen for coronary disease: results from the trial to assess chelation therapy randomized trial

Abstract

Background: The National Institutes of Health.funded Trial to Assess Chelation Therapy (TACT) randomized 1708 stablecoronary disease patients aged .50 years who were .6 months post.myocardial infarction (2003.2010) to 40 infusions ofa multicomponent EDTA chelation solution or placebo. Chelation reduced the primary composite end point of mortality,recurrent myocardial infarction, stroke, coronary revascularization, or hospitalization for angina (hazard ratio, 0.82; 95%confidence interval, 0.69.0.99; P=0.035).

Methods and results: In a randomly selected subset of 911 patients, we prospectively collected a battery of quality-of-life(QOL) instruments at baseline and at 6, 12, and 24 months after randomization. The prespecified primary QOL measures were the Duke Activity Status Index (Table I in the Data Supplement) and the Medical Outcomes Study Short-Form 36 Mental Health Inventory-5. All comparisons were by intention to treat. Baseline clinical and QOL variables were well balanced in the 451 patients randomized to chelation and in the 460 patients randomized to placebo. The Duke Activity Status Index improved in both groups during the first 6 months of therapy, but we found no evidence for a treatment-related difference (mean difference [chelation.placebo] during follow-up, 0.9 [95% confidence interval, .0.7 to 2.6; P=0.27]).There was no statistically significant evidence of a treatment-related difference in the Mental Health Inventory-5 during follow-up (mean difference, 1.0; 95% confidence interval, .0.1 to 2.0; P=0.08). None of the secondary QOL measures showed a consistent treatment-related difference.

Conclusions: In stable, predominantly asymptomatic coronary disease patients with a history of myocardial infarction,EDTA chelation therapy did not have a detectable effect on QOL during 2 years of follow-up.

Clinical trial registration: URL: https://ichgcp.net/clinical-trials-registry/NCT00044213" title="See in ClinicalTrials.gov">NCT00044213.

Conflict of interest statement

Disclosures: No other authors reported conflicts of interest.

Figures

Figure 1

Reasons for Missing Quality of Life Data in the Trial to Assess Chelation Therapy.

Figure 2

Duke Activity Status Index. Scores range from 0 (worst) to 58.2 (best) and reflect the ability of patients to do physical activities without difficulty or assistance in 12 domains. Graph represents observed data shown by intention to treat.

Figure 3

Short Form-36 (SF-36) Mental Health Inventory (MHI-5). The MHI-5 assesses psychological well-being, including depression and anxiety with scores ranging from 0 (worst) to 100 (best).