Brack Hattler1,2, Brendan M Carr3, John Messenger2, John Spertus4, Ramin Ebrahimi5,6, Muath Bishawi3,7, Jacquelyn A Quin8,9, G Hossein Almassi10,11, Joseph F Collins12, Elizabeth Kozora2,13, Frederick L Grover1,2, A Laurie W Shroyer3. 1. Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.). 2. University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.). 3. Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.). 4. Saint Luke's Mid America Heart Institute/University of Missouri at Kansas City, Kansas City, MO (J.S.). 5. Greater Los Angeles VA Medical Center, Los Angeles, CA (R.E.). 6. University of California, Los Angeles (R.E.). 7. Duke University, Durham, NC (M.B.). 8. VA Boston Healthcare System, West Roxbury, MA (J.A.Q.). 9. Harvard Medical School, Boston, MA (J.A.Q.). 10. Zablocki Veterans Affairs Medical Center, Milwaukee, WI (G.H.A.). 11. Medical College of Wisconsin, Milwaukee (G.H.A.). 12. Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.). 13. National Jewish Health, Denver, CO (E.K.).
Abstract
BACKGROUND: Studies of the relationship between patient self-reported angina symptoms using the Seattle Angina Questionnaire (SAQ) and angiographic findings after coronary artery bypass grafting surgery (CABG) are lacking. Nested within a randomized controlled trial, this prospective observational cohort comparison study aimed to assess which clinical characteristics and angiographic findings are associated with self-reported angina 1 year after CABG. METHODS AND RESULTS:Patients from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified 1-year post-CABG coronary angiography and SAQ assessments were included (n=1258). Patients reporting no angina (62.3%) within 4 weeks before the 1-year post-CABG study visit on the SAQ angina frequency domain were compared with patients reporting angina (37.7%). Multivariable modeling identified clinical variables and angiographic findings associated with angina. Sequential univariate and multivariable modeling found the following demographic and clinical factors were associated with angina after CABG: younger age, worse preoperative SAQ angina frequency score, smoking, diabetes mellitus, and pre-CABG depression. The only 1-year angiographic finding significantly associated with angina was incomplete revascularization of the left anterior descending (LAD) territory. Graft occlusions, incomplete revascularization of non-LAD territories, and ≥70% lesions in nonrevascularized native coronary arteries were not correlated with the presence or absence of angina. Further, only 30.6% of subjects reporting angina at 1 year had a residual major coronary artery stenosis of ≥70%. CONCLUSIONS:Self-reported angina 1 year after CABG is associated with younger age, worse baseline SAQ angina frequency score, smoking, diabetes mellitus, and depression. The only angiographic finding associated with angina was a poorly revascularized LAD territory. These results may help guide physicians when counseling patients on expected improvements in angina symptoms and in making decisions regarding the need for coronary angiography after CABG. Whether intensive treatment of these comorbidities improves post-CABGangina symptoms requires further study. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00032630.
RCT Entities:
BACKGROUND: Studies of the relationship between patient self-reported angina symptoms using the Seattle Angina Questionnaire (SAQ) and angiographic findings after coronary artery bypass grafting surgery (CABG) are lacking. Nested within a randomized controlled trial, this prospective observational cohort comparison study aimed to assess which clinical characteristics and angiographic findings are associated with self-reported angina 1 year after CABG. METHODS AND RESULTS:Patients from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified 1-year post-CABG coronary angiography and SAQ assessments were included (n=1258). Patients reporting no angina (62.3%) within 4 weeks before the 1-year post-CABG study visit on the SAQangina frequency domain were compared with patients reporting angina (37.7%). Multivariable modeling identified clinical variables and angiographic findings associated with angina. Sequential univariate and multivariable modeling found the following demographic and clinical factors were associated with angina after CABG: younger age, worse preoperative SAQangina frequency score, smoking, diabetes mellitus, and pre-CABG depression. The only 1-year angiographic finding significantly associated with angina was incomplete revascularization of the left anterior descending (LAD) territory. Graft occlusions, incomplete revascularization of non-LAD territories, and ≥70% lesions in nonrevascularized native coronary arteries were not correlated with the presence or absence of angina. Further, only 30.6% of subjects reporting angina at 1 year had a residual major coronary artery stenosis of ≥70%. CONCLUSIONS: Self-reported angina 1 year after CABG is associated with younger age, worse baseline SAQangina frequency score, smoking, diabetes mellitus, and depression. The only angiographic finding associated with angina was a poorly revascularized LAD territory. These results may help guide physicians when counseling patients on expected improvements in angina symptoms and in making decisions regarding the need for coronary angiography after CABG. Whether intensive treatment of these comorbidities improves post-CABG angina symptoms requires further study. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00032630.
Authors: Mario Gaudino; Antonino Di Franco; Deepak L Bhatt; John H Alexander; Antonio Abbate; Lorenzo Azzalini; Sigrid Sandner; Garima Sharma; Sunil V Rao; Filippo Crea; Stephen E Fremes; Sripal Bangalore Journal: Eur Heart J Date: 2021-04-07 Impact factor: 29.983