Abstract 15026: Association of De-Escalation of Anti-Anginal Medications With Angina After Percutaneous Coronary Intervention
Background: At the time of percutaneous coronary intervention (PCI), anti-anginal medications (AAM) may be discontinued, even though angina persists in ~20% of patients. Frequency of AAM discontinuation and its association with post-PCI angina has not been described.
Methods: In a 10-center PCI registry, patients were assessed for angina 6 months after PCI with the Seattle Angina Questionnaire and categorized as no angina (Angina Frequency score=100) vs any angina (score<100). AAM de-escalation was defined as being on fewer AAM at discharge than admission. The association of AAM de-escalation with 6-month angina was examined using logistic regression after adjusting for the predicted risk of post-PCI angina (using a previously validated prediction model) and completeness of revascularization. Testing for interactions between AAM de-escalation, predicted risk of angina and completeness of revascularization.
Results: Of 2743 PCI patients (70% male, 18% NSTEMI), AAM were de-escalated, unchanged, and increased in 189 (7%), 1922 (70%), and 632 (23%) patients, respectively. The proportion of patients with angina at 6 months was significantly higher in those whose AAM were de-escalated (37%) vs unchanged (24%) or increased (20%; p<0.001), with a significant interaction between AAM de-escalation and completeness of revascularization (p=0.009) suggesting that the greatest impact was in those with incomplete revascularization (Figure). After adjustment for risk of post-PCI angina and the completeness of revascularization, de-escalation of AAMs was associated with 39% increased risk of angina at 6-months post PCI (RR 1.39, 95% CI 1.12-1.72).
Conclusions: While de-escalation of AAMs does not occur commonly after PCI, it was associated with an increased risk of angina, particularly among those with incomplete revascularization.
Author Disclosures: A. Towheed: None. M. Qintar: None. F. Tang: None. A.C. Salisbury: Research Grant; Significant; Boston Scientific. Honoraria; Modest; Abiomed, Medtronic. J.A. Spertus: Research Grant; Modest; NHLBI, AHA, ACCF, Lilly, EvaHeart, Amorcyte. Honoraria; Modest; United Healthcare, Genentech, Amgen. Ownership Interest; Significant; Health Outcomes Sciences, the commercial entity distributing and supporting ePRISM,, Owns copyrights to the Seattle Angina Questionnaire. S.V. Arnold: None.
- © 2016 by American Heart Association, Inc.