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.
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.


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.
Venkitachalam
Lakshmi
L
Cardiovascular Institute, Department of Medicine, School of Medicine, Graduate School of Public Health, University of Pittsburgh, PA, USA. lvenkitachalam@saint-lukes.org
Kip
Kevin E
KE
Mulukutla
Suresh R
SR
Selzer
Faith
F
Laskey
Warren
W
Slater
James
J
Cohen
Howard A
HA
Wilensky
Robert L
RL
Williams
David O
DO
Marroquin
Oscar C
OC
Sutton-Tyrrell
Kim
K
Bunker
Clareann H
CH
Kelsey
Sheryl F
SF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology*; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D005260:Female; D006760:Hospitalization; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D009566:Nitrates / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D019233:Retreatment; D012737:Sex Factors; D015607:Stents; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D000960:Hypolipidemic Agents; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin