Predictors of post PCI angina
Among the complications of ischemic cardiomyopathy stenting, those called chronic, with significant functional and mental compromise, might affect patient quality of life. This can be observed in different scenarios, such as instent restenosis and post PCI angina. This kind of complications is associated with anxiety and depression at long term.
According to data from the ISCHEMIA trial, patients with moderate to severe ischemia, initially randomized to an invasive strategy, improved their health status vs. a conservative approach (even more in patients with baseline angina). Also, according to prior registries and studies, post PCI angina can affect from 20 to 40% of patients in the short and mid-term.
The TARGET-FFR was designed to assess the efficacy of FFR guided PCI optimization vs. the conventional angiography guided PCI. This study incorporated patients with chronic o acute coronary syndrome, stable, randomized 1:1, with symptom follow up according to the Seattle Angina Questionnaire (SAQ-7) and health status monitoring according to the European quality of life-5 dimension-5 level (EQ-5D-5L). Post-PCI angina was defined by follow-up SAQ-angina frequency score <100 (SAQ =100 meaning angina free).
Mean followup was 3 years after PCI; clinical primary end point was target vessel failure (composite end point of cardiovascular death, target vessel MI, target vessel revascularization).
Read also: BASILICA: a Complex Strategy, Yet Safe.
230 patients were included, mean age 60, 87.8% men, 38.3% with post PCI angina according to SAQ score. 5.7% of these angina patients did not have prior angina (iatrogenic effect).
Angina patients presented, at baseline, higher ACS incidence and prior PCI vs. angina free-patients, and the presence of atrial fibrillation and smoking was also more frequent among angina patients.
Coronary angiograms showed no difference in stenosis severity between the groups. Surprisingly, angina free patients had more severe lesions upon physiological analysis and presented more apparent improvement of post PCI indices (hyperemic and non-hyperemic). Post PCI assessment showed no differences in these variables either.
Read also: Low Gradient Aortic Stenosis: Is Invasive Assessment Viable?
Looking at symptoms, SAQ score was significantly lower, both at baseline and followup, in angina patients. Though moderate, FFR had a positive correlation with SAQ score, as did CFR (weaker correlation). FFR delta after PCI also showed a weak correlation. Single and multivariable analysis determined that small FFR changes after procedure predicted post PI angina.
Primary end point incidence at followup was 1.7%, with no differences between the angina and angina free groups ((0.7% vs 3.4; P=0.16).
Conclusions
Post PCI residual angina was seen in 38.3% of patients undergoing PCI. Also, these patients presented more symptoms at baseline (according to SAQ) and more often had a history of revascularization and smoking. Baseline FFR and FFR changes were the most important predictors of freedom from angina after PCI.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Original Title: Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors.
Reference: Collison D, Copt S, Mizukami T, Collet C, McLaren R, Didagelos M, Aetesam-Ur-Rahman M, McCartney P, Ford TJ, Lindsay M, Shaukat A, Rocchiccioli P, Brogan R, Watkins S, McEntegart M, Good R, Robertson K, O’Boyle P, Davie A, Khan A, Hood S, Eteiba H, Berry C, Oldroyd KG. Angina After Percutaneous Coronary Intervention: Patient and Procedural Predictors. Circ Cardiovasc Interv. 2023 Apr;16(4):e012511. doi: 10.1161/CIRCINTERVENTIONS.122.012511. Epub 2023 Mar 28. PMID: 36974680; PMCID: PMC10101135.
Subscribe to our weekly newsletter
Get the latest scientific articles on interventional cardiology
