COMPLETE QOL Study Finds Complete Revascularization Reduces Angina, Improves QOL

Complete revascularization may result in an improved angina-related quality of life (QOL) in patients with STEMI and multivessel coronary artery disease (CAD) when compared with patients who received culprit-lesion-only PCI, according to results from the COMPLETE QOL study presented April 2 during ACC.22.

The main results from the COMPLETE trial, reported in 2019, showed that complete revascularization reduced cardiovascular death or new myocardial infarction in patients with STEMI or multivessel CAD – findings that led to a class 1A recommendation for complete revascularization in the 2021 ACC/AHA/AATS/STS/SCAI Guideline for Coronary Artery Revascularization.

The impact of complete revascularization on angina-related QOL is unclear and has not been studied in a randomized trial. For this prespecified analysis, Shamir R. Mehta, MD, FACC, et al., administered the Seattle Angina Questionnaire at baseline, six months and at a final visit at a median of three years. Patients completed the 19-item questionnaire to assess their frequency of angina, physical limitation, treatment satisfaction and QOL. Scores ranged from 0 to 100 for each category with a higher score indicating better health status and fewer symptoms. In addition, patients were randomized to the complete revascularization cohort (n=2,016) or the culprit-lesion-only PCI cohort (n=2,025).

Results showed that at the three-year follow-up, the angina frequency score was 97.1±9.7 for the complete revascularization cohort vs. 96.3±10.9 for the culprit-lesion-only cohort. Also, in the complete revascularization cohort vs. the culprit-lesion-only cohort, respectively, the physical limitation score was 91.1±15.7 vs. 89.9±17.4; treatment satisfaction score was 93.3±12.4 vs. 92.5±13.2; QOL score was 83.6±18.0 vs. 82.5±18.4; and the summary score was 90.7±11.4 vs. 89.5±12.2.

At the end of study, more patients were angina free in the complete revascularization cohort (87.5% vs. 84.3% in the culprit-lesion-only cohort; absolute risk difference, 3.2%; p=0.013), with a number needed to treat of 31.

The benefit of complete revascularization was observed entirely in patients with nonculprit lesion stenosis severity ≥80%, and the researchers stated this difference was notable because of the crossover to nonculprit lesion PCI in the culprit-lesion-only cohort after an angina-related ischemic event.

"Complete revascularization improves overall patient-reported health status in addition to its established benefit in reducing major cardiovascular events," the investigators conclude. "These data also provide important new information for physicians to consider in the context of shared decision-making as it relates to coronary artery revascularization in patients with STEMI."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease

Keywords: ACC Annual Scientific Session, ACC22, Angina, Unstable, Myocardial Revascularization, Quality of Life, Coronary Artery Disease, Percutaneous Coronary Intervention, Myocardial Infarction

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