Abstract
Background: Empiric data on whether patients with diabetes suffer a differing burden of angina are conflicting. Population studies have found similar or less angina in patients with diabetes, whereas studies in patients with ACS or MI have found more angina. Few studies have incorporated coronary angiographic findings. Methods: We examined all 203 patients undergoing non-emergent PCI at our institution who completed a baseline patient-reported outcomes survey using a novel mobile technology platform integrated with the EMR between January-September, 2014. The primary exposure was diabetes status. The primary outcome was angina burden as measured by the Seattle Angina Questionnaire (SAQ) Short Form summary score (lower scores indicate worse angina). We additionally examined SAQ sub-scores for angina severity, physical limitation, and quality of life. Additional covariates selected a priori included age, race, gender, smoking, hypertension, dyslipidemia, history of MI, PCI, or heart failure, CAD presentation (asymptomatic, stable angina, UA, or NSTEMI), and number of major epicardial vessels with ≥50% stenosis on angiography. Analyses were performed using multivariable linear regression. Results: In our study, 79 patients (39%) had diabetes. Mean SAQ summary score for patients with diabetes was 55.2 (SD 28.3) versus 64.3 (SD 25.4) among patients without diabetes. In the unadjusted model, diabetes was associated with a significantly lower SAQ summary score (B: -9.1; 95% CI: -16.83, -1.38), which persisted in the fully adjusted model (B: -7.36; 95% CI: -14.19, -0.52). This effect was driven by sub-scores for angina severity (B: -7.45; 95% CI: -14.67, -0.24) and physical limitation (B: -10.88, 95% CI: -19.03, -2.72), with no association between diabetes and quality of life. Conclusion: Patients undergoing PCI with diabetes had worse burden of angina relative to those without diabetes, despite controlling for historical and angiography findings. This effect was driven by angina severity and physical limitation. Our results can guide future clinical decision-making regarding angina symptoms in this high-risk diabetic cohort. Furthermore, our study demonstrates that using a mobile technology platform is feasible for routine assessment of angina in patients with and without diabetes undergoing PCI.
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