Predictors for change in quality of life in patients with chronic coronary syndrome undergoing PCI

Abstract Background In patients with chronic coronary syndrome (CCS), percutaneous coronary intervention (PCI) is performed to relieve symptoms of angina pectoris and to improve quality of life (QoL) after optimal medical therapy. However, it remains uncertain whether there are specific patient-related characteristics associated with lack of improvement in general and disease-specific health status after PCI. Purpose This study aimed to evaluate changes in health status among the general CCS population one year after PCI compared to baseline. In addition, it aimed to identify patient-related characteristics associated with the absence of health status improvement. Methods Data were derived from the Southeast Netherlands Heart Registry, an ongoing, multicenter PCI registry. To assess disease-specific health status, the shortened version of Seattle Angina Questionnaire (SAQ-7) was used. To determine change in general health, the 36-Item Short Form Health Survey (SF36-v2) was used. Scores were subdivided into a physical health (PH) component and a mental health (MH) component. Patients with complete questionnaires at baseline and one year after PCI were included. The associations with baseline characteristics were examined using univariable binary logistic regression. Results Repeated SAQ-7 data were available for 302 patients (25%). At baseline, 19% reported having no angina over the past month, which increased to 57% of patients one year after PCI. The overall summary score of disease-specific health improved in 72% of patients. Active smoking and the presence of multivessel disease showed a trend towards a lack of improvement in disease-specific health status. In addition, higher baseline scores in the three subdomains of SAQ-7 were associated with higher chance of no improvement (Figure 1). Repeated SF36-v2 data were available for 329 patients (28%). One year after PCI, PH improved in 58% of patients and MH in 56% of patients. Patients with peripheral artery disease (PAD) had a 1.9x higher chance of no improvement of PH compared to patients without PAD (OR=1.939, 95% CI: 1.001-3.757). Again, higher baseline values were associated with higher chance of no improvement. In addition, diabetes, male sex, a previous myocardial infarction, active smoking, and obesity showed a trend towards no PH improvement one year after PCI (Figure 2). Conclusion This study shows that only 55% of CCS patients reported improved general health one year after PCI. However, 72% of patients reported improved disease-specific health status one year after PCI, with a significant increase in patients who were angina-free. Furthermore, reported baseline values of health were inversely associated with improvement in QoL. In addition, PAD was associated with the absence of improvement in the physical component of QoL. Further research should focus on identifying characteristics of CCS patients who may derive less benefit from PCI to adequately inform patients.Figure 1:Forest plot SAQ7 Figure 2:Forest plot SF36v2