Absence of symptoms in Stable Ischemic Heart Disease predicts complications after PCI

Ischemic heart disease is known to be caused by atherosclerotic or thrombotic obstruction of coronary arteries. Clinical manifestation of ischemic heart disease expands from asymptomatic atherosclerosis of coronary arteries to acute coronary syndromes (ACS) including unstable angina, acute myocardial infarction. Age is a strong independent risk factor for the development of atherosclerotic arterial disease. It is predicted that upcoming decades, tremendous increase of the prevalence of Stable Ischemic Heart Disease (SIHD) in the older adults.

A recent cohort study by Dr Anoop N Koshy, MBBS and team revealed that patients who underwent revascularization for SIHD, and reported absence of symptoms were associated with higher rates of periprocedural complications and, adjustment of more important clinical variables, led to finding of independent predictor of long-term mortality. Revascularization in SIHD is mainly targeted for angina relief, the appropriateness of Percutaneous Coronary Intervention (PCI) in the absence of symptoms mandates justification for ischemic heart disease.

The findings of the study are published in American Heart Journal.

The objective of the study was to evaluate whether symptom status affects periprocedural safety and long-term mortality in patients undergoing PCI.

The study prospectively enrolled consecutive patients undergoing PCI for SIHD at six hospitals in Australia between 2005 to 2018 as part of the Melbourne Interventional Group registry. Symptom status was recorded at the time of PCI and patients undergoing staged PCI were excluded.

The results of the study were

• A total of 11,730 patients with SIHD were followed up for a median period of 5 years (maximum 14.0 years, interquartile range 2.2-9.0 years) with 1,317 (11.2%) being asymptomatic.

• Asymptomatic patients were older, and more likely to be male, have triple-vessel disease, with multiple comorbidities including renal failure, diabetes and heart failure (all P < .01).

• These patients had significantly higher rates of periprocedural complications and major adverse cardiovascular events at 30-days.

• Long-term mortality was significantly higher in asymptomatic patients (27.2% vs 18.0%, P < .001).

• On cox regression for long-term mortality, after adjustment for more important clinical variables, asymptomatic status was an independent predictor (Hazard ratio (HR) 1.39 95% CI 1.16-1.66, P < .001)

Dr Koshy and team concluded that "In a real-world cohort of patients undergoing revascularization for SIHD, absence of symptoms was associated with higher rates of periprocedural complications and, after adjustment for more important clinical variables, was an independent predictor of long-term mortality. As the primary goal of revascularization in SIHD remains angina relief, the appropriateness of PCI in the absence of symptoms warrants justification"

Reference: https://doi.org/10.1016/j.ahj.2021.10.190