Background: In addition to angina pectoris and dyspnoea, patients with chronic coronary syndrome (CCS) often experience a markedly reduced quality of life (QoL). Interventional therapy is currently under critical discussion regarding effectivity and therefore the goal of our analysis is to evaluate the effect of PCI on symptoms and QoL in a real-world all-comer collective of patients from the prospective PLA-pCi-EBO-trial with angina pectoris.

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, 145 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 PCI on CCS symptoms and QoL in the overall cohort. Angina pectoris symptom burden and QoL were assessed with the Seattle Angina Questionnaire (SAQ) at baseline and one and six months after PCI. SAQ subscales range from 0 (worst symptoms) to 100 (no symptoms). Dyspnoea was assessed using the NYHA scale.

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. There was a strong and highly significant improvement for the SAQ subscales one and six months after PCI: QoL (+34±25; +34±25), physical limitation (+20±25; +32±23), angina frequency (+26±22; +25±23), and angina stability (+39±33; +24±32). These improvements occurred quickly after one month and were sustained long-term after six months. In addition to being statistically significant (p<0.001), the range of increases in SAQ subscales can be translated to clinically highly relevant improvements.

Dyspnoea can be difficult to treat in patients with CCS. In our cohort, 63% (n=92) of patients presented with dyspnoea in addition to angina pectoris (NYHA class I: 25.5%; NYHA class II: 38.6%; NYHA class III: 35.2%; NYHA class IV: 0.7%). Nearly half of all patients experienced an improvement of at least one NYHA class one and six months after PCI (47% and 44% respectively, p<0.001, U-test). Notably, 47% and 50% of the patients with no change in NYHA class after one or six months respectively already had class I at baseline.

Conclusion: These data show that PCI provides quick and sustainable symptomatic relief and improved quality of life in a prospective clinical multicenter trial with a well-characterized patients suffering from CCS.