Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization.
BACKGROUND
It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization.


METHODS
We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%).


RESULTS
Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80)


CONCLUSIONS
In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.
Lenzen
Mattie
M
Department of Cardiology, Clinical Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Scholte op Reimer
Wilma
W
Norekvål
Tone M
TM
De Geest
Sabina
S
Fridlund
Bengt
B
Heikkilä
Johanna
J
Jaarsma
Tiny
T
Mårtensson
Jan
J
Moons
Philip
P
Smith
Karen
K
Stewart
Simon
S
Strömberg
Anna
A
Thompson
David R
DR
Wijns
William
W
D000203:Activities of Daily Living; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000523:psychology; D015906:Angioplasty, Balloon, Coronary / Q000523:psychology; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D001294:Attitude to Health; D000075202:Contraindications; D001026:Coronary Artery Bypass / Q000523:psychology; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome