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Complete Revascularization and Angina-Related Health Status
Quick Takes
- Findings from this prespecified analysis from the landmark ISCHEMIA trial show that an invasive strategy led to complete revascularization in only 50% of patients.
- When complete revascularization is achieved, it is associated with greater health status improvement than incomplete revascularization.
- Invasive strategy (complete or incomplete revascularization) was associated with greater health status gain than conservative management.
- The benefit of complete revascularization was largely seen among patients with daily or weekly angina and minimally among patients with monthly angina or asymptomatic patients.
Study Questions:
What is the impact of complete revascularization (CR) on angina-related health status (symptoms, function, quality of life) in chronic coronary disease (CCD)?
Methods:
Multivariable regression adjusting for patient characteristics was used to compare 12-month health status after independent core laboratory-defined CR versus incomplete revascularization (ICR) in patients who underwent invasive (INV) management. Propensity-weighted modeling was then performed to estimate the treatment effect had CR or ICR been achieved in all INV patients, compared with conservative (CON) management.
Results:
Anatomic and functional CR were achieved in 43.3% and 57.8% of 1,641 INV patients, respectively. Among revascularized patients, CR was associated with improved Seattle Angina Questionnaire Angina Frequency compared to ICR after adjustment for baseline differences. After modeling CR and ICR in all INV patients, patients with CR and ICR each had greater improvements in health status than CON, with better health status with CR than ICR. The projected benefits of CR were most pronounced in patients with baseline daily/weekly angina and not seen in those with no angina.
Conclusions:
Among patients with CCD in the ISCHEMIA trial, health status improved more with CR compared with ICR or CON, particularly in those with frequent angina. Anatomic and functional CR provided comparable improvements in quality of life.
Perspective:
Findings from this prespecified analysis from the landmark ISCHEMIA trial show: 1) an INV strategy led to CR in only 50% of patients; 2) when CR was achieved, it was associated with greater health status improvement than IR; 3) among all trial participants, INV strategy (CR or ICR) was associated with greater health status gain than CON management; and 4) the benefit of CR was mainly seen among patients with daily or weekly angina and not among patients without angina or monthly angina. For patients with frequent angina, striving for CR offers the greatest improvement in quality-of-life measures.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and SIHD, Interventions and Coronary Artery Disease
Keywords: Angina Pectoris, Chronic Disease, Coronary Artery Disease, Coronary Disease, Health Status, Myocardial Ischemia, Myocardial Revascularization, Quality of Life
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