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Published on: March 27, 2018
Clinical and Angiographic Predictors of Patient-Reported Angina 1 Year After Coronary Artery Bypass Graft Surgery
Brack Hattler1,2, Brendan M Carr3, John Messenger2
1Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.).
Insights
One year after coronary artery bypass grafting (CABG), patient-reported angina is linked to younger age, worse baseline scores, smoking, diabetes, and depression. Incomplete revascularization of the left anterior descending (LAD) artery was the only angiographic factor associated with persistent angina.
Area of Science:
- Cardiology
- Cardiac Surgery
- Patient-Reported Outcomes
Background:
- Limited studies explore the link between patient-reported angina and angiographic findings post-coronary artery bypass grafting (CABG).
- This study investigates clinical and angiographic predictors of persistent angina symptoms one year after CABG.
Purpose of the Study:
- To identify clinical characteristics and angiographic findings associated with self-reported angina symptoms one year after CABG.
- To inform patient counseling and decisions regarding post-CABG coronary angiography.
Main Methods:
- Prospective observational cohort study nested within the ROOBY trial (n=1258).
- Utilized Seattle Angina Questionnaire (SAQ) for angina assessment and coronary angiography at one year post-CABG.
- Multivariable modeling identified predictors of angina frequency.
Main Results:
- Younger age, worse baseline SAQ angina frequency, smoking, diabetes mellitus, and pre-CABG depression were associated with post-CABG angina.
- Incomplete revascularization of the left anterior descending (LAD) territory was the sole angiographic correlate of angina.
- A significant portion of patients with angina (69.4%) did not have severe (≥70%) residual coronary stenosis.
Conclusions:
- Patient-reported angina one year after CABG is influenced by specific clinical factors and incomplete LAD revascularization.
- Findings may aid physicians in managing patient expectations and guiding further investigations.
- Further research is needed to determine if treating comorbidities improves post-CABG angina.
Background:
Studies of the relationship between patient self-reported angina symptoms using the Seattle Angina Questionnaire (SAQ) and angiographic findings after coronary artery bypass grafting surgery (CABG) are lacking. Nested within a randomized controlled trial, this prospective observational cohort comparison study aimed to assess which clinical characteristics and angiographic findings are associated with self-reported angina 1 year after CABG.
Methods And Results:
Patients from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified 1-year post-CABG coronary angiography and SAQ assessments were included (n=1258). Patients reporting no angina (62.3%) within 4 weeks before the 1-year post-CABG study visit on the SAQ angina frequency domain were compared with patients reporting angina (37.7%). Multivariable modeling identified clinical variables and angiographic findings associated with angina. Sequential univariate and multivariable modeling found the following demographic and clinical factors were associated with angina after CABG: younger age, worse preoperative SAQ angina frequency score, smoking, diabetes mellitus, and pre-CABG depression. The only 1-year angiographic finding significantly associated with angina was incomplete revascularization of the left anterior descending (LAD) territory. Graft occlusions, incomplete revascularization of non-LAD territories, and ≥70% lesions in nonrevascularized native coronary arteries were not correlated with the presence or absence of angina. Further, only 30.6% of subjects reporting angina at 1 year had a residual major coronary artery stenosis of ≥70%.
Conclusions:
Self-reported angina 1 year after CABG is associated with younger age, worse baseline SAQ angina frequency score, smoking, diabetes mellitus, and depression. The only angiographic finding associated with angina was a poorly revascularized LAD territory. These results may help guide physicians when counseling patients on expected improvements in angina symptoms and in making decisions regarding the need for coronary angiography after CABG. Whether intensive treatment of these comorbidities improves post-CABG angina symptoms requires further study.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov . Unique identifier: NCT00032630.
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