Michael Wester1, Franziska Koll1, Mark Luedde2, Christoph Langer3, Markus Resch4, Andreas Luchner5, Karolina Müller6, Florian Zeman6, Michael Koller6, Lars S Maier1, Samuel Sossalla7. 1. Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. 2. Kardiologische Gemeinschaftspraxis Bremerhaven, Bremerhaven, Germany. 3. Kardiologisch-Angiologische Praxis, Heart Centre Bremen, Bremen, Germany. 4. Department of Internal Medicine I, St. Josef Hospital, Regensburg, Germany. 5. Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany. 6. Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany. 7. Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. samuel.sossalla@ukr.de.
Abstract
BACKGROUND: Dyspnea is a frequent symptom in patients with stable coronary artery disease (CAD) and is recognized as a possible angina equivalent. OBJECTIVES: This study was to assess the impact of percutaneous coronary intervention (PCI) on dyspnea, quality of life, and angina pectoris in patients with stable CAD. METHODS: The prospective, multi-center PLA-pCi-EBO-pilot trial included 144 patients with symptomatic stable CAD and successful PCI. The prespecified endpoints angina pectoris (Seattle Angina Questionnaire-SAQ) and dyspnea (NYHA scale) were assessed 6 months after PCI. Predictors for symptomatic improvement were assessed with uni- and multivariable logistic regression analyses. RESULTS: Patients with concomitant dyspnea had worse SAQ physical limitation scores at baseline (49.5 ± 21.0 vs 58.9 ± 22.0, p = 0.013) but showed no difference for angina frequency or quality of life. Overall, symptomatic burden of angina pectoris and dyspnea was alleviated by PCI. However, patients with concomitant dyspnea had markedly worse scores for physical limitation (78.9 ± 25.0 vs 94.3 ± 10.6, p < 0.001), angina frequency (77.9 ± 22.8 vs 91.1 ± 12.4, p < 0.001), and quality of life (69.4 ± 24.1 vs 82.5 ± 14.4, p < 0.001) after PCI. The prevalence of dyspnea (NYHA class ≥ 2) declined from 73% before PCI to 54%. Of 95 initially dyspneic patients, 57 (60%) improved at least one NYHA class 6 months after PCI. In a multivariable logistic regression analysis, "atypical angina pectoris" was associated with improved NYHA class, whereas "diabetes mellitus" had a negative association. CONCLUSION: PCI effectively reduced dyspnea, which is a frequent and demanding symptom in patients with CAD. The German Clinical Trials Register registration number is DRKS0001752 ( www.drks.de ).
BACKGROUND: Dyspnea is a frequent symptom in patients with stable coronary artery disease (CAD) and is recognized as a possible angina equivalent. OBJECTIVES: This study was to assess the impact of percutaneous coronary intervention (PCI) on dyspnea, quality of life, and angina pectoris in patients with stable CAD. METHODS: The prospective, multi-center PLA-pCi-EBO-pilot trial included 144 patients with symptomatic stable CAD and successful PCI. The prespecified endpoints angina pectoris (Seattle Angina Questionnaire-SAQ) and dyspnea (NYHA scale) were assessed 6 months after PCI. Predictors for symptomatic improvement were assessed with uni- and multivariable logistic regression analyses. RESULTS: Patients with concomitant dyspnea had worse SAQ physical limitation scores at baseline (49.5 ± 21.0 vs 58.9 ± 22.0, p = 0.013) but showed no difference for angina frequency or quality of life. Overall, symptomatic burden of angina pectoris and dyspnea was alleviated by PCI. However, patients with concomitant dyspnea had markedly worse scores for physical limitation (78.9 ± 25.0 vs 94.3 ± 10.6, p < 0.001), angina frequency (77.9 ± 22.8 vs 91.1 ± 12.4, p < 0.001), and quality of life (69.4 ± 24.1 vs 82.5 ± 14.4, p < 0.001) after PCI. The prevalence of dyspnea (NYHA class ≥ 2) declined from 73% before PCI to 54%. Of 95 initially dyspneic patients, 57 (60%) improved at least one NYHA class 6 months after PCI. In a multivariable logistic regression analysis, "atypical angina pectoris" was associated with improved NYHA class, whereas "diabetes mellitus" had a negative association. CONCLUSION: PCI effectively reduced dyspnea, which is a frequent and demanding symptom in patients with CAD. The German Clinical Trials Register registration number is DRKS0001752 ( www.drks.de ).
Authors: Stephan D Fihn; Julius M Gardin; Jonathan Abrams; Kathleen Berra; James C Blankenship; Apostolos P Dallas; Pamela S Douglas; Joanne M Foody; Thomas C Gerber; Alan L Hinderliter; Spencer B King; Paul D Kligfield; Harlan M Krumholz; Raymond Y K Kwong; Michael J Lim; Jane A Linderbaum; Michael J Mack; Mark A Munger; Richard L Prager; Joseph F Sabik; Leslee J Shaw; Joanna D Sikkema; Craig R Smith; Sidney C Smith; John A Spertus; Sankey V Williams; Jeffrey L Anderson Journal: Circulation Date: 2012-11-19 Impact factor: 29.690
Authors: Mohammed Qintar; J Aaron Grantham; James Sapontis; Kensey L Gosch; William Lombardi; Dimitri Karmpaliotis; Jeffery Moses; Adam C Salisbury; David J Cohen; John A Spertus; Suzanne V Arnold Journal: Circ Cardiovasc Qual Outcomes Date: 2017-12
Authors: Juhani Knuuti; William Wijns; Antti Saraste; Davide Capodanno; Emanuele Barbato; Christian Funck-Brentano; Eva Prescott; Robert F Storey; Christi Deaton; Thomas Cuisset; Stefan Agewall; Kenneth Dickstein; Thor Edvardsen; Javier Escaned; Bernard J Gersh; Pavel Svitil; Martine Gilard; David Hasdai; Robert Hatala; Felix Mahfoud; Josep Masip; Claudio Muneretto; Marco Valgimigli; Stephan Achenbach; Jeroen J Bax Journal: Eur Heart J Date: 2020-01-14 Impact factor: 29.983
Authors: Suzanne J Baron; Khaja Chinnakondepalli; Elizabeth A Magnuson; David E Kandzari; John D Puskas; Ori Ben-Yehuda; Gerrit-Anne van Es; David P Taggart; Marie-Claude Morice; Nicholas J Lembo; W Morris Brown; Adrian Banning; Charles A Simonton; A Pieter Kappetein; Joseph F Sabik; Patrick W Serruys; Gregg W Stone; David J Cohen Journal: J Am Coll Cardiol Date: 2017-10-30 Impact factor: 24.094
Authors: Panagiotis Xaplanteris; Stephane Fournier; Nico H J Pijls; William F Fearon; Emanuele Barbato; Pim A L Tonino; Thomas Engstrøm; Stefan Kääb; Jan-Henk Dambrink; Gilles Rioufol; Gabor G Toth; Zsolt Piroth; Nils Witt; Ole Fröbert; Petr Kala; Axel Linke; Nicola Jagic; Martin Mates; Kreton Mavromatis; Habib Samady; Anand Irimpen; Keith Oldroyd; Gianluca Campo; Martina Rothenbühler; Peter Jüni; Bernard De Bruyne Journal: N Engl J Med Date: 2018-05-22 Impact factor: 91.245
Authors: William E Boden; Robert A O'Rourke; Koon K Teo; Pamela M Hartigan; David J Maron; William J Kostuk; Merril Knudtson; Marcin Dada; Paul Casperson; Crystal L Harris; Bernard R Chaitman; Leslee Shaw; Gilbert Gosselin; Shah Nawaz; Lawrence M Title; Gerald Gau; Alvin S Blaustein; David C Booth; Eric R Bates; John A Spertus; Daniel S Berman; G B John Mancini; William S Weintraub Journal: N Engl J Med Date: 2007-03-26 Impact factor: 91.245
Authors: John A Spertus; Philip G Jones; David J Maron; Sean M O'Brien; Harmony R Reynolds; Yves Rosenberg; Gregg W Stone; Frank E Harrell; William E Boden; William S Weintraub; Khaula Baloch; Kreton Mavromatis; Ariel Diaz; Gilbert Gosselin; Jonathan D Newman; Stavroula Mavromichalis; Karen P Alexander; David J Cohen; Sripal Bangalore; Judith S Hochman; Daniel B Mark Journal: N Engl J Med Date: 2020-03-30 Impact factor: 91.245
Authors: Rasha Al-Lamee; David Thompson; Hakim-Moulay Dehbi; Sayan Sen; Kare Tang; John Davies; Thomas Keeble; Michael Mielewczik; Raffi Kaprielian; Iqbal S Malik; Sukhjinder S Nijjer; Ricardo Petraco; Christopher Cook; Yousif Ahmad; James Howard; Christopher Baker; Andrew Sharp; Robert Gerber; Suneel Talwar; Ravi Assomull; Jamil Mayet; Roland Wensel; David Collier; Matthew Shun-Shin; Simon A Thom; Justin E Davies; Darrel P Francis Journal: Lancet Date: 2017-11-02 Impact factor: 79.321