Abstract 11: Predicting Angina for Stable Coronary Patients with or Without Percutaneous Coronary Intervention

Abstract

Background: Relief of angina and improvement in quality of life is the most common indication for percutaneous coronary intervention (PCI) in stable ischemic heart disease (SIHD). Given that there are alternative strategies for treating angina, (e.g. intensifying optimal medical therapy (OMT) or PCI), predicting angina severity as a function of alternative treatment options can serve as a foundation for shared decision-making and the elicitation of patients’ preferences. Methods: Using data from the 2,287 SIHD patients in COURAGE trial, where PCI was randomized, we built multivariable linear regression models of Seattle Angina Questionnaire (SAQ)-assessed angina, physical function and quality of life at 6 and 12 months, using baseline SAQ scores, treatment, and all demographic and clinical characteristics available at the time of randomization. Results: At baseline, there were no significant differences between PCI and OMT groups for any SAQ domain. The strongest predictors of 6- and 12-month SAQ scores were patients’ baseline scores. Different characteristics had different degrees of association with angina, physical function and quality of life domains, with PCI being associated with 1.9-5.3-point greater improvement in SAQ scores, depending upon the domain and time frame. The adjusted R 2 of final models varied from 0.38-0.62. The results (regression coefficients with standard errors and adjusted R 2 ) of patients characteristics associated with SAQ scores for 6-month and 1-year are presented in table. Conclusions: Prediction models can be created to estimate patient-centered health status outcomes and could be used as an evidence-based foundation for supporting shared medical decision-making in SIHD. The impact of such models on treatment decisions needs to be assessed in future studies. Patient Characteristics associated with Seattle Angina Questionnaire Scores 1 Domain Time Frame Physical limitation Angina Frequency Quality of Life Factor β(SE) Factor β(SE) Factor β(SE) 6-month SAQ scores Baseline Score * Age(<65) * Gender(F) PreviousPCI E-F 3 Hypertension * MI * PCI * Diabetes * 0.51(0.02) 5.21(1.10) -1.32(1.56) -0.10(1.45) 0.15(1.40) 2.87(1.08) 2.87(1.15) 5.07(1.01) 5.22(1.14) Baseline Score * Age(<65) Gender(F) PreviousPCI E-F 3 Hypertension MI PCI * diabetes 0.28(0.02) 1.09(1.09) 0.43(1.48) 2.14(1.71) 0.98(1.42) -0.28(1.14) 1.49(1.14) 4.75(1.02) 1.56(1.11) Baseline Score * Age(<65) Gender(F) PreviousPCI E-F 3 Hypertension MI PCI * Diabetes * 0.36(0.02) -0.40(1.13) 1.12(1.53) 2.69(1.62) 1.64(1.48) -0.20(1.16) 1.95(1.19) 5.30(1.07)3.13(1.16) Adjusted R 2 0.62 Adjusted R 2 0.43 Adjusted R 2 0.42 1-year SAQ scores Baseline Score * Age(<65) * Gender(F) PreviousPCI E-F 3 Hypertension * MI PCI Diabetes * 0.46(0.03) 3.91(1.17) -0.34(1.62) 1.10(1.66) 2.21(1.57) 3.14(1.16) 2.02(1.21) 1.88(1.11) 4.64(1.22) Baseline Score * Age(<65) * Gender(F) PreviousPCI E-F 3 Hypertension MI PCI * Diabetes * 0.26(0.02) 2.12(1.05) -0.54(1.48) 0.15(1.61) 1.06(1.35) 0.51(1.11) 0.84(1.118) 3.65(0.98) 4.29(1.11) Baseline Score * Age(<65) Gender(F) PreviousPCI E-F 3 Hypertension MI PCI * Diabetes * 0.29(0.02) -1.85(1.11) 0.06(1.58) 0.94(1.65) 0.75(1.53) 0.39(1.16) 1.59(1.18) 3.12(1.08) 2.81(1.19) Adjusted R 2 0.48 Adjusted R 2 0.38 Adjusted R 2 0.41 1 Scale: 0-100; * With p <0.05; . 2 E-F: Ejection Fraction; 3 MI: Myocardial Infarction.