Outcomes/Effectiveness Research

Patients who have preprocedural angina appear to derive the most benefit from coronary angioplasty

Patients suffering from angina (crushing chest pain) appear to derive the greatest improvement in quality of life from nonemergency percutaneous coronary intervention (PCI), while asymptomatic patients achieve substantially less benefit. Doctors need to carefully consider whether the benefits of PCI outweigh the risks of the procedure for asymptomatic patients, concludes John A. Spertus, M.D., M.P.H., of the University of Missouri-Kansas City.

In a study that was supported in part by the Agency for Healthcare Research and Quality (HS11282), Dr. Spertus and his colleagues examined the association between baseline patient characteristics and post-PCI quality of life of 1,518 patients who underwent nonemergency PCI at one medical center. Overall, PCI conferred substantial benefit to patients who underwent the procedure. The mean Seattle Angina Questionnaire (SAQ) Physical Limitation, Angina Frequency, and Quality-of-Life scores increased by 18, 24, and 30 points, respectively. However, the benefit for individual patients varied considerably.

For example, only 17 percent and 19 percent of patients without angina experienced moderate and large improvement in their quality of life compared with 13 and 72 percent, respectively, of those with angina. These results underscore the critical role of angina at the time of PCI as a predictor of procedural benefit from the patients' perspectives. Fewer than 36 percent of patients without angina had significant clinical improvement in their quality of life compared with more than 85 percent of those who suffered from at least some angina. Finally, patients with mild, moderate, and severe baseline physical limitations improved 13.8, 20.0, and 13.5 points more than those with minimal physical limitations. These findings persisted even after correcting for baseline differences in demographic, clinical, disease severity, and health status variables.

See "Predictors of quality-of-life benefit after percutaneous coronary intervention," by Dr. Spertus, Adam C. Salisbury, Philip G. Jones, M.S., and others, in the December 21, 2004, Circulation 110, pp. 3789-3794.

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