Real-World Data Show Correlation Between Post-PCI Angina, Resource Utilization

Post-procedural angina, chest pain and ACS remain common challenges despite improvements over time in PCI. Data presented at TCT 2014 suggest that patients in whom angina and chest pain recur utilize significantly more health care resources and should be targeted for prevention strategies.

In a retrospective analysis of patient administrative claims data, Ori Ben-Yehuda, MD, executive director of the CRF Clinical Trials Center, New York, N.Y., looked at inpatient procedures, such as angioplasty and implantation of drug-eluting stents (DES) and bare-metal stents (BMS). Procedures were performed in patients aged older than 18 years (n=51,756) from January 2008 to December 2011. Mean patient age was 61.8 years, and 72.4% were men.

All patients had data for at least 1 year prior to and 1 year after the procedure. Ben-Yehuda said the researchers took a “conservative approach” to defining post-PCI angina to ensure an accurate representation.

At 12, 24 and 36 months, the incidence of angina or chest pain in all PCI patients was 24.8%, 33.9% and 40%, respectively. The incidence of post-PCI angina and/or chest pain was “remarkably similar” between DES patients and the overall group of PCI patients, Ben-Yehuda reported.

In the overall population, ACS occurred in 2.7% of patients at 12 months, 4.1% at 24 months and 5.3% at 36 months.

“There are several lines of evidence to support that the findings are very reasonable,” Ben-Yehuda said. “One is the consistency across BMS and DES. The other is that we actually are replicating what is seen in clinical trials.”

Utilization of resources

Presence of chest pain and/or angina correlated with significant increases in repeat PCI, CV hospital admission, diagnostic angiography, stress testing, and emergency room visits at 1 year compared with patients who did not experience symptoms (see Table).

Also at 1-year follow-up, patients who had angina and/or chest pain, but no ACS, made more visits to medical professionals than those who did not (mean, 0.8 vs. 0.3; P<.001), as well as more emergency room visits (mean 1.3 vs. 0.5; P<.001) and office visits (mean 12.2 vs. 9.7;P<.001). Additionally, repeat PCI was higher in patients with ACS than in those without.

“Health care utilization gives you an indirect assessment of the severity of symptoms,” Ben-Yehuda concluded, adding that strategies to reduce post-PCI angina or chest pain could have substantial impact on the outcomes and costs of ischemic heart disease.

Disclosures:

• Ben-Yehuda reports no relevant conflicts of interest.
• The study was funded by Abbott Vascular.