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Assessment of activity status and survival according to the Canadian Cardiovascular Society angina classification

Padma Kaul1, C David Naylor, Paul W Armstrong

  • 1Division of Cardiology, University of Alberta, Edmonton, Alberta T6G 2M8, Canada. pkaul@ualberta.ca

The Canadian Journal of Cardiology
|July 9, 2009
PubMed

Insights

The Canadian Cardiovascular Society angina (CCSA) classification shows good validity against the Duke Activity Status Index (DASI) and predicts long-term mortality. A revised CCSA definition may improve prognostic accuracy by including symptom stability.

Area of Science:

  • Cardiology
  • Clinical Outcomes Research

Background:

  • Limited data exist on the validity of the Canadian Cardiovascular Society angina (CCSA) classification relative to other functional status measures.
  • The CCSA classification is widely used to assess angina severity.

Purpose of the Study:

  • To assess the validity of the CCSA classification by comparing it with the Duke Activity Status Index (DASI).
  • To evaluate the prognostic significance of the CCSA classification regarding long-term mortality.

Main Methods:

  • 1407 patients undergoing cardiac catheterization (1992-1996) were analyzed.
  • Median follow-up was 9.7 years, with mortality data available for all patients until December 31, 2004.

Main Results:

  • CCSA classes I-III showed an inverse relationship with DASI scores (P<0.01).
  • Higher CCSA class correlated with increased long-term mortality, independent of baseline characteristics.
  • Symptom course (stable vs. unstable) modulated mortality risk in CCSA classes III and IV.

Conclusions:

  • CCSA classes I-III correlate inversely with DASI, and CCSA linearly associates with mortality.
  • The similarity in outcomes for CCSA classes III and IV may be due to symptom stability confounding results.
  • A revised CCSA definition incorporating symptom stability could enhance prognostic value for high-risk patients.
Abstract

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