Role of palliative percutaneous coronary intervention in severely symptomatic complex coronary artery disease patients who could not undergo coronary artery bypass surgery

Abstract

Context: Patients with symptomatic complex coronary artery disease (CAD) who could not undergo bypass surgery for any reason often continue to have symptoms and impaired quality of life (QoL) on optimal medical therapy (OMT) Aims: This study aimed to evaluate the role of palliative percutaneous coronary intervention (PCI) in these patients as compared to OMT alone. Settings and Design: This was a prospective, questionnaire-based, case–control, single-center study. Subjects and Methods: Patients in the case arm underwent palliative PCI of at least 1 target vessel and the control arm remained on OMT. The primary endpoint was a comparison of Seattle Angina Questionnaire (SAQ)-angina frequency (AF) and QoL scores at baseline, 3 months, and 6 months. Secondary outcomes were the difference in frequency of cardiovascular death, stroke, nonfatal myocardial infarction, and major bleeding episodes between 2 arms during the same period. Results: The study recruited 200 patients (100 in each arm). Baseline characteristics were well matched. Presenting diagnosis was stable CAD in 11% and ACS in 89%. SAQ AF and QoL scores were similar in both arms at baseline, but a significant improvement in both parameters was seen at 3 and 6 months in palliative PCI arm. Predecided cutoffs for significant improvement in SAQ-AF and SAQ-QoL were achieved in palliative PCI arm. No significant difference was seen for secondary outcome measures between the two groups. Conclusions: Palliative PCI provided a significant benefit in terms of improvement in SAQ-AF and SAQ-QoL scores, over short term (6 months), as compared to OMT alone in patients with severely symptomatic complex CAD, who could not undergo CABG.