Temporal trends in patient-reported angina at 1 year after percutaneous coronary revascularization in the stent era: a report from the National Heart, Lung, and Blood Institute-sponsored 1997-2006 dynamic registry

Abstract

Background: Percutaneous coronary intervention (PCI) has witnessed rapid technological advancements, resulting in improved safety and effectiveness over time. Little, however, is known about the temporal impact on patient-reported symptoms and quality of life after PCI.

Methods and results: Temporal trends in post-PCI symptoms were analyzed using 8879 consecutive patients enrolled in the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry (wave 1: 1997 [bare metal stents], wave 2: 1999 [uniform use of stents], wave 3: 2001 [brachytherapy], wave 4, 5: 2004, 2006 [drug eluting stents]). Patients undergoing PCI in the recent waves were older and more often reported comorbidities. However, fewer patients across the waves reported post-PCI angina at one year (wave 1 to 5: 24%, 23%, 18%, 20%, 20%; P(trend)<0.001). The lower risk of angina in recent waves was explained by patient characteristics including use of antianginal medications at discharge (relative risk [95% CI] for waves 2, 3, 4 versus 1: 1.0 [0.9 to 1.2], 0.9 [0.7 to 1.1], 1.0 [0.8 to 1.3], 0.9 [0.7 to 1.1]). Similar trend was seen in the average quality of life scores over time (adjusted mean score for waves 1 to 5: 6.2, 6.5, 6.6 and 6.6; P(trend)=0.01). Other factors associated with angina at 1 year included younger age, female gender, prior revascularization, need for repeat PCI, and hospitalization for myocardial infarction over 1 year.

Conclusions: Favorable temporal trends are seen in patient-reported symptoms after PCI in routine clinical practice. Specific subgroups, however, remain at risk for symptoms at 1 year and thus warrant closer attention.

Figure 1

Relative risk (95% confidence intervals) for angina at one year after PCI in the NHLBI-sponsored 1997–2006 Dynamic Registry waves MI: Myocardial infarction; PCI: Percutaneous coronary intervention; PVD: Peripheral vascular disease, SA: Stable angina; UA; Unstable angina.

Figure 2

Temporal trends in supplemental therapy* following index PCI in the NHLBI-sponsored 1997–2006 Dynamic Registry * Supplemental therapy following index PCI comprised of the following mutually exclusive groups: 1) Bypass surgery alone or with PCI, 2) Repeat PCI or, 3) pharmacological maintenance therapy only (PMT, 1 of beta-blockers, calcium channel blockers and long-acting nitrates); †P_trend calculated using the Jonckeheere-Terpstra test for ordinal variables; PMT: Pharmacological maintenance therapy ( 1 of beta-blockers, calcium channel blockers and long-acting nitrates)