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Minority Have Repeat Angina At One Year After Percutaneous Coronary Intervention

Although some 75 percent of patient have been found angina-free at one year following percutaneous coronary intervention, women continue to have more symptoms, a study of the US National Health Lung and Blood Institute Dynamic Registry indicates.

More angina symptoms also were found in other subgroups, including patients with history of myocardial infarction or previous intervention, reports clinicians at the Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. They studied 1,755 consecutive patients who underwent percutaneous coronary intervention (PCI) because of symptoms or acute infarction.

The clinicians said they carried out the study because PCI is most commonly performed for relief of angina, and it is important to identify factors associated with recurrence of angina symptoms.

They found at one year follow-up that 26 percent of the patients reported they had had angina in the previous six weeks. A greater number of symptoms were reported among women and younger patients.

At the same time, this association of angina at follow-up was seen among patients who had had coronary artery bypass graft (CABG) or PCI, prior myocardial infarction (MI), diabetes, graft disease, and extensive coronary artery disease (CAD) with more than four significant lesions.

A lower incidence of angina was seen among patients who were receiving statins: 24 percent compared with 28 percent among those who were not. Patients who had been completely revascularized, and patients with residual single-vessel disease, had comparable one year angina rates of 23 percent in each groups. Angina rates were 32 percent among patients with residual multi-vessel CAD.

Patients who had a repeat PCI during follow-up (34 percent) reported more angina at one year. Patients who underwent CABG after post-PCI hospitalization had less symptoms (15 percent). When clinicians adjusted for baseline symptom status and outcome of index PCI, residual CAD, and reintervention during follow-up, they found that patient characteristics significantly predictive of angina included women, patients under the age of 62, and prior MI.

They conclude that as the angina symptoms "are associated with self-reported activity and quality of life limitation, evaluations of PCI should include angina as a key follow-up outcome."
Am Heart J 2002 Nov;144(5):826-33. "Angina 1 year after percutaneous coronary intervention: a report from the NHLBI Dynamic Registry."

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