Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction in China

Abstract

Key Points Question What is the self-perceived angina-specific health status before and after percutaneous coronary intervention (PCI) among patients without acute myocardial infarction in China? Findings In this cohort study of 1611 Chinese patients without acute myocardial infarction undergoing elective PCI, 27.5% had stable coronary artery disease and 72.5% had unstable angina. Of patients undergoing PCI for stable coronary artery disease, 25.7% had no reported angina symptoms at the time of the procedure, and patients with smaller clinical improvements in angina symptom burden at 1 year following PCI had significantly higher baseline Seattle Angina Questionnaire scores for all scales. Meaning These findings highlight the importance of ascertaining impairment from angina among patients without acute myocardial infarction prior to performing PCI.

Listen to Your Patient

“…It is in this context that the study by Lu et al sheds new insights. Lu et al considered the extent to which 1611 patients enrolled in the large China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Prospective Study—and who received PCI in the absence of MI—benefited from treatment . The analysis expands our understanding of how PCI is used in the world’s most populous country in several fundamental ways.…”

“…Irrespective of these reasons, the study findings by Lu et al 4 raise concern that many patients could be exposed to the risks of an invasive procedure with a low likelihood of benefit. Fortunately, in patients who did self-report angina symptoms, most (>90%) reported symptom relief at 1 year, and roughly half of patients reported improved quality of life 1 year after PCI.…”

Chinese patients’ clinical and psychosocial outcomes in the 6 months following percutaneous coronary intervention

“…However, there have not been many studies, including in lower-resource settings, where cardiac and/or PCI outpatients are followed to determine their rate of adverse cardiovascular events (ACE), risk factor control and quality of life (QoL), including angina symptoms [5,6,10]. We know that risk of recurrent events is even higher in those with CVD who also suffer from psychosocial distress such as depression and anxiety as well as sleep issues [11,12], and this type of distress can be higher in China [13].…”

“…The high rate [ 3 ] of PCIs performed has led to concerns about the appropriateness, risks and benefits of these procedures in patients who undergo them [ 5 ]. Indeed, in one study which tracked 1600 Chinese patients who underwent PCI for stable coronary artery disease, they found that 26% of the patients had no pre-procedural angina symptoms [ 6 ].…”

“…The SAQ QoL subscale scores can be translated into very poor to poor (0-24), fair (25-49), good (50-74), and excellent (75-100) quality of life. As per previous work, we considered an increase in the SAQ subscale scores of 10 or more points as clinically significant improvement[6]. *p < 0.05, **p < .01, ***p < 0.001 Liu et al BMC Cardiovasc Disord (HADS subscale scores over the 6-month follow-up from the percutaneous coronary intervention, n = 491.…”