Abstract 222: Angina Severity, Depression, and Response to PCI in Patients With Chronic Total Occlusion of Coronary Arteries

Abstract

Background: Chronic total occlusions of coronary arteries (CTOs) are common in patients with chronic angina. Patients with chronic angina exhibit rates of depression that are higher than the general population, and depressed patients with coronary disease have a poorer prognosis. The study aims were to quantify rates of depression in patients referred for CTO PCI, determine whether depression is related to symptom severity, and determine whether depression modifies the effect of PCI on symptoms. Methods and Results: The study enrolled 56 consecutive patients referred for CTO PCI at a single center between 10/2013 and 10/2014. PCI was successful in 48/54 (88.9%) patients. 45 patients had complete data and were included. Responses to Seattle Angina Questionnaire (SAQ7), Rose Dyspnea Scale (RDS), and Patient Health Questionnaire (PHQ-2) were recorded in the medical record routinely on the day of the procedure and after 30 days. Data were abstracted from the medical record along with demographic, clinical, and procedural data. Depression was defined as PHQ-2 score ≥3 with 18/45 (40%) depressed at baseline. There were few differences in demographics, comorbidities, or medical therapy between depressed and non-depressed groups. PHQ-2 was linearly correlated with symptoms, most highly with SAQ7-SS (R2=0.264, p=0.0002) and RDS (R2=0.289, p=0.0001). Baseline SAQ7-SS and SAQ7-AF scores for depressed patients were 35.4 [28.4-42.4] and 54.4 [43.0-65.8], compared with 67.3 [57.5-77.1] and 77.8 [68.5-87.1] for non-depressed patients (p<0.0001 and p=0.003). All scores improved significantly between the pre- and post-procedure measurements (p<0.0001). Depressed patients had significantly larger improvements in their symptoms. Mean improvement in SAQ7-SS and SAQ7-AF scores for depressed patients were 48.5 [35.4-61.5] and 32.8 [21.0-44.5], compared with 16.5 [5.87-27.2] and 12.6 [3.0-22.2] for patients without depression (p=0.0004 and p=0.01). Fewer patients reported depression after PCI, with 5/45 (11.1%) patients reporting depression post-PCI (p=0.003 compared with 40% pre-PCI rate). Conclusions: Depression is common among patients with CTO, and is associated with increased angina severity. Depressed patients undergoing CTO PCI have a more dramatic improvement in their angina symptoms and depression.