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Effect of PCI on quality of life in patients with stable coronary disease
William S Weintraub1, John A Spertus, Paul Kolm
1Christiana Care Health System, Newark, DE 19718, USA. wweintraub@christianacare.org
Insights
Percutaneous coronary intervention (PCI) provided small, temporary quality of life benefits for stable coronary artery disease patients compared to optimal medical therapy alone. These incremental benefits, particularly for severe angina, disappeared by 36 months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- The incremental benefit of percutaneous coronary intervention (PCI) over optimal medical therapy (OMT) for quality of life in chronic coronary artery disease remains unclear.
- Stable coronary artery disease (CAD) management often involves OMT, but the role of PCI in improving patient-reported outcomes needs further investigation.
Purpose of the Study:
- To compare the quality of life and health status of patients with stable coronary artery disease undergoing PCI plus OMT versus OMT alone.
- To assess the incremental benefits of PCI on angina symptoms, physical function, and mental well-being over a 36-month period.
Main Methods:
- A randomized trial involving 2287 patients with stable coronary artery disease.
- Patients were assigned to either PCI plus OMT or OMT alone.
- Health status was evaluated using the Seattle Angina Questionnaire and the RAND 36-item health survey.
Main Results:
- At 3 months, the PCI group showed a higher rate of angina freedom (53% vs. 42%) and improved Seattle Angina Questionnaire scores across multiple domains, including physical limitation, angina stability, angina frequency, treatment satisfaction, and quality of life.
- Incremental benefits from PCI were observed for 6 to 24 months, with greater benefits noted in patients experiencing more severe angina.
- By 36 months, no significant differences in health status were detected between the PCI and OMT groups.
Conclusions:
- Both PCI plus OMT and OMT alone led to significant improvements in health status for patients with stable angina.
- PCI offered small, statistically significant incremental benefits in quality of life that diminished and disappeared by 36 months.
- The findings suggest that while PCI may provide short-term advantages, long-term quality of life outcomes are similar to optimal medical therapy alone in stable CAD.
Background:
It has not been clearly established whether percutaneous coronary intervention (PCI) can provide an incremental benefit in quality of life over that provided by optimal medical therapy among patients with chronic coronary artery disease.
Methods:
We randomly assigned 2287 patients with stable coronary disease to PCI plus optimal medical therapy or to optimal medical therapy alone. We assessed angina-specific health status (with the use of the Seattle Angina Questionnaire) and overall physical and mental function (with the use of the RAND 36-item health survey [RAND-36]).
Results:
At baseline, 22% of the patients were free of angina. At 3 months, 53% of the patients in the PCI group and 42% in the medical-therapy group were angina-free (P<0.001). Baseline mean (+/-SD) Seattle Angina Questionnaire scores (which range from 0 to 100, with higher scores indicating better health status) were 66+/-25 for physical limitations, 54+/-32 for angina stability, 69+/-26 for angina frequency, 87+/-16 for treatment satisfaction, and 51+/-25 for quality of life. By 3 months, these scores had increased in the PCI group, as compared with the medical-therapy group, to 76+/-24 versus 72+/-23 for physical limitation (P=0.004), 77+/-28 versus 73+/-27 for angina stability (P=0.002), 85+/-22 versus 80+/-23 for angina frequency (P<0.001), 92+/-12 versus 90+/-14 for treatment satisfaction (P<0.001), and 73+/-22 versus 68+/-23 for quality of life (P<0.001). In general, patients had an incremental benefit from PCI for 6 to 24 months; patients with more severe angina had a greater benefit from PCI. Similar incremental benefits from PCI were seen in some but not all RAND-36 domains. By 36 months, there was no significant difference in health status between the treatment groups.
Conclusions:
Among patients with stable angina, both those treated with PCI and those treated with optimal medical therapy alone had marked improvements in health status during follow-up. The PCI group had small, but significant, incremental benefits that disappeared by 36 months. (ClinicalTrials.gov number, NCT00007657.)
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