For more than 30 years, research has indicated that PCI decreases mortality in STEMI and reduces recurrent ischemic events in patients with non-ST elevation acute coronary syndrome. The overriding goal in performing PCI for these patients is to reduce morbidity and mortality, but quality of life (QOL) is another important aspect to consider.
Studies comparing QOL after PCI versus medical therapy or CABG generally report on angina, but this is only one symptom that is relieved by coronary interventions. PCI can also enhance the ability to function, exercise, and perform activities of daily living in many patients. Some comorbidities, however, can limit QOL before and after PCI and may minimize the chances of any improvement in QOL after undergoing the procedure.
Individualizing Approaches for PCI & CABG
The Society of Cardiovascular Angiography and Interventions (SCAI) released a consensus statement on the effect of PCI on QOL. Published in an issue of Catheterization and Cardiovascular Interventions, the document recommends that clinicians take into consideration that improvements in QOL due to PCI vary from patient to patient. For example, patients who are severely limited by angina will have dramatic improvements in QOL if PCI relieves the angina. However, patients who are severely limited by other medical problems may not experience much improvement in QOL after PCI.
Investigations comparing CABG to PCI suggest that QOL is better in the first few months after PCI. At 3 to 5 months, QOL is similar for both PCI and CABG. After 1, 3, and even 5 years, however, QOL tends to be better for patients who receive CABG. When counseling patients on treatment decisions, SCAI emphasizes that clinicians take this information into account and inform patients of the likelihood of an improved QOL outcome.
Involving patients throughout the decision-making process can improve QOL outcomes and foster the development of treatment plans that make the most sense for patients, depending on their preferences. Patients need to be fully informed of the trade-offs when they’re considering treatment options.
Oftentimes, the benefits of revascularization procedures are overestimated while the safety and effectiveness of medical therapy are underestimated. This highlights the need to fully inform patients on the risks and benefits of any interventions being considered and to think about QOL in all aspects of care.
Looking Ahead on the Effects of PCI
Continuous research on revascularization and medical therapy for patients with stable ischemic heart disease requires ongoing reassessment of the effects of PCI and other coronary interventions on QOL. More data are forthcoming, but clinicians can turn to the SCAI consensus statement in the meantime for guidance in treating this complex patient population.
Download the Full Consensus!
Click here to obtain the SCAI consensus statement on the effect of PCI on quality of life (pdf).
Readings & Resources (click to view)
Blankenship J, Marschall J, Pinto D, et al. Effect of percutaneous coronary intervention on quality of life: a consensus statement from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv. 2012, March 19. [Epub ahead of print].
Blankenship J, Scott T, Skelding K, et al. Door-to-balloon times under 90 min can be routinely achieved for patients transferred for ST-segment elevation myocardial infarction percutaneous coronary intervention in a rural setting. J Am Coll Cardiol, 2011;57:272-279.
Zhang S, Ge J, Yao K, Qian J. Meta-analysis of early versus deferred revascularization for non-ST-segment elevation acute coronary syndrome. Am J Cardiol. 2011;108:1207-1213.
Chan P, Patel M, Klein L, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306:53-61.