In addition to angina pectoris, patients with chronic coronary syndrome (CCS) often report dyspnea. The relevance of concomitant dyspnea for improvements of symptom burden and quality of life after percutaneous coronary intervention (PCI) remain unclear. We evaluated this in a real-world all-comer collective of patients with angina pectoris from the prospective PLA-pCi-EBO-trial.
Methods:
This is an additional analysis from the prospective randomized PLA-pCi-EBO-trial including 5 academic and large communal hospitals in Germany. In this trial, 144 patients with symptomatic CCS underwent PCI. The image group received a print-out of their coronary status before and after PCI highlighting successful invasive treatment to evaluate the effect of graphical positive reinforcement on the symptomatic outcome of PCI.
Here, we analyze the effect of concomitant dyspnea on the improvements in symptom burden and quality of life in the whole study collective. Angina pectoris symptom burden and quality of life were assessed with the Seattle Angina Questionnaire (SAQ) at baseline and six months after PCI. SAQ subscales range from 0 (worst symptoms) to 100 (no symptoms). Dyspnea was assessed using the NYHA scale and a NYHA class ≥2 was rated as concomitant dyspnea.
Result:
The effect of the intervention of this study (i.e. the demonstration of the angiography of the stented coronary artery after PCI) compared to standard clinical practice was not significant (Wester et al., JACC Interv, 2021).
We then analyzed the effect of PCI on the whole study cohort of which 52 (36%) patients presented with concomitant dyspnea and 92 patients presented without concomitant dyspnea. At baseline, patients with concomitant dyspnea had a lower physical limitation score (49.5±21.0 vs 58.9±22.0, p=0.013) than patients without concomitant dyspnea. There was no difference between the two groups regarding angina stability (32.1±22.6 vs 29.3±26.5, p=0.514), angina frequency (56.5±18.5 vs 61.5±15.9, p=0.103), or quality of life (39.4±20.8 vs 39.1±16.3, p=0.929) at baseline. Both groups without and with concomitant dyspnea strongly improved six months after PCI. However, patients with concomitant dyspnea had lower scores six months after PCI for physical limitation (78.9±25.0 vs 94.3±1, p<0.001), angina frequency (77.9±22.8 vs 91.7±12.4, p<0.001), and quality of life (69.4±24.1 vs 82.5±14.4, p<0.001) which are clinically and statistically highly significant.
Conclusion:
These data show that concomitant dyspnea is a common and highly relevant symptom in chronic coronary syndrome which negatively affects symptomatic relief and improvement in quality of life after PCI in patients with chronic coronary syndrome.
https://dgk.org/kongress_programme/ht2022/aP727.html