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Original Articles

Temporal Trends in Patient-Reported Angina at 1 Year After Percutaneous Coronary Revascularization in the Stent Era

A Report From the National Heart, Lung, and Blood Institute–Sponsored 1997–2006 Dynamic Registry

Lakshmi Venkitachalam, PhD; Kevin E. Kip, PhD; Suresh R. Mulukutla, MD; Faith Selzer, PhD; Warren Laskey, MD; James Slater, MD; Howard A. Cohen, MD; Robert L. Wilensky, MD; David O. Williams, MD; Oscar C. Marroquin, MD; Kim Sutton-Tyrrell, DrPH; Clareann H. Bunker, PhD; Sheryl F. Kelsey, PhD for the NHLBI-Sponsored Dynamic Registry Investigators

From the Cardiovascular Institute, Department of Medicine, School of Medicine (L.V., S.R.M., O.C.M.), and the Department of Epidemiology (F.S., K.S.-T., C.H.B., S.F.K.), Graduate School of Public Health, University of Pittsburgh, Pa; the College of Nursing (K.E.K.), University of South Florida, Tampa, Fla; the University of New Mexico School of Medicine (W.L.), Albuquerque, NM; the Department of Cardiology (J.S.), New York University Medical Center, New York, NY; Lenox Hill Hospital (H.A.C.), New York, NY; the Cardiovascular Division (R.L.W.), University of Pennsylvania, Philadelphia, Pa; and the Cardiovascular Division (D.O.W.), Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Lakshmi Venkitachalam, PhD, Mid America Heart Institute, Saint Luke’s Hospital, 4400 Wornall Rd, Fifth Floor, Kansas City, MO 64111. E-mail lvenkitachalam{at}saint-lukes.org

Received March 27, 2009; accepted August 19, 2009.

Background— Percutaneous coronary intervention (PCI) has witnessed rapid technological advancements, resulting in improved safety and effectiveness over time. Little, however, is known about the temporal impact on patient-reported symptoms and quality of life after PCI.

Methods and Results— Temporal trends in post-PCI symptoms were analyzed using 8879 consecutive patients enrolled in the National Heart, Lung, and Blood Institute–sponsored Dynamic Registry (wave 1: 1997 [bare metal stents], wave 2: 1999 [uniform use of stents], wave 3: 2001 [brachytherapy], wave 4, 5: 2004, 2006 [drug eluting stents]). Patients undergoing PCI in the recent waves were older and more often reported comorbidities. However, fewer patients across the waves reported post-PCI angina at one year (wave 1 to 5: 24%, 23%, 18%, 20%, 20%; P_trend<0.001). The lower risk of angina in recent waves was explained by patient characteristics including use of antianginal medications at discharge (relative risk [95% CI] for waves 2, 3, 4 versus 1: 1.0 [0.9 to 1.2], 0.9 [0.7 to 1.1], 1.0 [0.8 to 1.3], 0.9 [0.7 to 1.1]). Similar trend was seen in the average quality of life scores over time (adjusted mean score for waves 1 to 5: 6.2, 6.5, 6.6 and 6.6; P_trend=0.01). Other factors associated with angina at 1 year included younger age, female gender, prior revascularization, need for repeat PCI, and hospitalization for myocardial infarction over 1 year.

Conclusion— Favorable temporal trends are seen in patient-reported symptoms after PCI in routine clinical practice. Specific subgroups, however, remain at risk for symptoms at 1 year and thus warrant closer attention.

Key Words: angina • registries • catheter-based interventions: stents

Guest Editor for this article was Paul A. Heidenreich, MD.