Abstract 16934: Canadian Cardiovascular Society Angina Classification and Change in Quality of Life Following Percutaneous Coronary Intervention for Stable Coronary Disease

Abstract

Background: Appropriate Use Criteria (AUC) have been developed to support the more rational use of percutaneous coronary intervention (PCI). To date, however, the AUC have not been empirically validated. A key component in AUC determination for patients with stable coronary artery disease (CAD) is their symptom burden, as measured by Canadian Cardiovascular Society (CCS) angina class. We compared the association of CCS class at the time of PCI with improvements in quality of life (QOL) after PCI.

Methods: Within a 10-center PCI registry (PRISM [Personalized Risk Information Services Manager] Study), we examined the association between baseline CCS class and 1-year change in QOL, as assessed by the disease-specific and validated Seattle Angina Questionnaire (SAQ), in patients undergoing PCI for stable CAD.

Results: Of 516 patients undergoing PCI for stable CAD, the mean age was 66 + 9.8 years and 73% were men. Most patients were treated with statins (75%) and beta blockers (66%) prior to PCI. Baseline CCS class of 0, I, II, III, and IV were present in 35%, 9%, 28%, 16% and 11% of patients, respectively. Compared to patients with CCS Class I or II angina, those with class III or IV angina had a lower baseline QOL (55 ± 23 v. 47 ± 24, p < 0.001). The change in QOL after PCI by CCS class is shown in Figure 1. Baseline CCS class accounted for only 14% of the variation in QOL improvement. Of note, the change in QOL was similar for patients with mild (class I/II) angina and more severe (class III/IV) angina (28 ± 23 v. 32 ± 26 respectively), both of which were significantly larger than for patients without angina (p < 0.001).

Conclusions: Among patients undergoing PCI for non-acute indications, improvements in QOL were similar for those with mild and more severe angina, as assessed by CCS class. CCS class appears to have limited discrimination in predicting the magnitude of QOL benefits in patients undergoing stable PCI.