Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors

Abstract

Background: Twenty percent to 40% of patients are affected by angina after percutaneous coronary intervention (PCI), which is associated with anxiety, depression, impaired physical function, and reduced quality of life. Understanding patient and procedural factors associated with post-PCI angina may inform alternative approaches to treatment. Methods: Two hundred thirty patients undergoing PCI completed the Seattle Angina Questionnaire (SAQ-7) and European quality of life–5 dimension–5 level (EQ-5D-5L) questionnaires at baseline and 3 months post-PCI. Patients received blinded intracoronary physiology assessments before and after stenting. A post hoc analysis was performed to compare clinical and procedural characteristics among patients with and without post-PCI angina (defined by follow-up SAQ-angina frequency score <100). Results: Eighty-eight of 230 patients (38.3%) reported angina 3 months post-PCI and had a higher incidence of active smoking, atrial fibrillation, and history of previous myocardial infarction or PCI. Compared with patients with no angina at follow-up, they had lower baseline SAQ summary scores (69.48±24.12 versus 50.20±22.59, P <0.001) and EQ-5D-5L health index scores (0.84±0.15 versus 0.69±0.22, P <0.001). Pre-PCI fractional flow reserve (FFR) was lower among patients who had no post-PCI angina (0.56±0.15 versus 0.62±0.13, P =0.003). Percentage change in FFR after PCI had a moderate correlation with angina frequency score at follow-up ( r =0.36, P <0.0001). Patients with post-PCI angina had less improvement in FFR (43.1±33.5% versus 67.0±50.7%, P <0.001). There were no between-group differences in post-PCI FFR, coronary flow reserve, or corrected index of microcirculatory resistance. Patients with post-PCI angina had lower SAQ-summary scores (64.01±22 versus 95.16±8.72, P ≤0.001) and EQ-5D-5L index scores (0.69±0.26 versus 0.91±0.17, P ≤0.001) at follow-up. Conclusions: Larger improvements in FFR following PCI were associated with less angina and better quality of life at follow-up. In patients with stable symptoms, intracoronary physiology assessment can inform expectations of angina relief and quality of life improvement after stenting and thereby help to determine the appropriateness of PCI. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03259815.

The changes in health-related quality of life in stable coronary artery disease patients and intermediante coronary lesions after elective percutaneous coronary intervention

“…Важливою складовою прогнозування змін ЯЖ та відбору пацієнтів для ПКВ може стати оцінювання гемодинамічної значущості коронарних стенозів [17,32,33]. За результатами оцінювання функціональних даних на рівні коронарних уражень ми встановили, що досягнення цільового рівня FFR (≥ 0,90 ум.…”

After RIPCORD 2, FAME 3, FLOWER-MI and FUTURE: Has the Pressure Wire had its Day?

“…PCI achieves better functional results and improved patient-reported outcomes where it is applied to focal coronary artery disease. [ 25 , 37 ] We need to move away from slavishly adhering to an artificial, dichotomous clinical cut-off value for FFR and place just as much importance on the pattern of coronary disease in a vessel when deciding on the appropriateness of PCI.…”

Can We Predict Who Will Have Angina Relief From Percutaneous Coronary Intervention?

“…In this issue of the journal, Collison et al report a secondary analysis of the randomized TARGET-FFR (Trial of Angiography vs Pressure-Ratio-Guided Enhancement Techniques-Fractional Flow Reserve) to determine patient and procedural factors associated with angina post-PCI. 9 Briefly, TARGET-FFR sought to evaluate the benefits of physiology-guided PCI optimization strategy versus usual care with the interventional operator blinded to the post-PCI coronary physiology. 10 In the current study, the authors included 230 trial participants with stable angina or medically stabilized non-ST-segment-elevation myocardial infarction who underwent comprehensive coronary physiology prior to and immediately following PCI and completed Seattle Angina Questionnaire and EQ-5D-5L quality of life questionnaires at baseline and 3 months post-PCI.…”

“…There are a number of strengths of this secondary analysis of a robust randomized controlled trial. 9 Coronary physiology assessments were systematically performed in the target vessel before and after PCI. Standardized angina and quality of life surveys were administered by a research nurse blinded to the coronary physiology results.…”