Predictors of Quality-of-Life Benefit After Percutaneous Coronary Intervention

Abstract

Background-Improving patients' quality of life is a primary indication for percutaneous coronary intervention (PCI), yet little is known about patient characteristics associated with greater quality-of-life improvement from the procedure. This study was conducted to identify patient characteristics associated with quality-of-life benefit after PCI. Methods and Results-A consecutive series of 1518 patients undergoing PCI in nonacute myocardial infarction settings were prospectively enrolled into an observational study documenting their postprocedural health status. We examined univariate and multivariable associations between baseline patient characteristics and quality of life 1 year after the procedure using the disease-specific Seattle Angina Questionnaire (SAQ) to quantify the impact of patients' coronary disease on their quality of life. Baseline angina frequency and physical function were the strongest predictors of quality-of-life improvement 1 year after PCI. In comparing patients without angina to those experiencing monthly, weekly, and daily angina, the quality-of-life improvements (meanϮSEM) were 21.4Ϯ2.1, 30.7Ϯ2.2, and 34.6Ϯ2.6 points greater (PϽ0.001). Patients with mild, moderate, and severe physical limitation improved 13.8Ϯ1.9, 20.0Ϯ2.1, and 13.5Ϯ3.5 points more than those with minimal baseline physical limitation (PϽ0.001). These findings were maintained in multivariable models correcting for baseline differences in demographic, clinical, disease-severity, and health-status variables. Conclusions-Preprocedural angina frequency is the most important prognostic indicator of quality-of-life improvement after PCI. Although substantial quality-of-life benefits are attained in most patients with preprocedural angina, more careful consideration of the potential benefits and risks of the procedure are needed in asymptomatic patients.

Preditores de mudança na qualidade de vida após um evento coronariano agudo

“…Although age was considered a mortality predictor in patients with CAD in one year 7 and a determinant of quality of life alterations 18 , the patients in the present study who were 65 years or older presented a variation that was similar to the ones younger than 65. Conaway et al 19 , taking into account the aging of the North-American population and the prevalence of CAD, carried out a study showing that patients older than 75 submitted to MRS, despite the slow physical recovery, did not present differences regarding the frequency of angina and quality of life, when compared to the younger patients.…”

Canadian quality indicators for percutaneous coronary interventions

“…Indeed, recent studies have found substantial regional differences in post-PCI mortality across Canada, suggesting that there is an important opportunity to improve the quality of care and outcomes of PCI in all regions (6). Other data have also confirmed that substantial regional disparities exist in the utilization of cardiac invasive procedures (7)(8)(9).…”

Two-year outcomes in patients with mild refractory angina treated with enhanced external counterpulsation

“…Despite this, CCS angina class has been shown to be linearly associated with increasing rates of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), as well as all-cause mortality and nonfatal MI. [10][11][12] Revascularization has demonstrable mortality benefits in certain defined subsets of patients with coronary artery disease (e.g., left main, triple-vessel with compromised ventricular function). However, perhaps the major objective in most patients undergoing revascularization has been the relief of angina and improvement in quality of life.…”