Asymptomatic patients undergoing PCI for stable ischaemic heart disease have poorer long-term survival compared to symptomatic patients: results from a large multi-centre Australian registry.

Abstract

Background: Recent results from the ISCHAEMIA study demonstrated no prognostic benefit for PCI in stable ischaemic heart disease (SIHD). Patients with SIHD, however, may present with typical angina, angina equivalents or no symptoms. Such diversity in presentations raises the question whether symptom status affects prognosis. Methods: We prospectively collected data on consecutive patients undergoing PCI for SIHD at six Victorian public hospitals between 2005-2018 as part of the Melbourne Interventional Group registry. Symptom status at PCI was recorded and patients undergoing staged PCI were excluded. Results: Overall, 10,949 patients with SIHD were included and 1203 (11.0%) were asymptomatic. Asymptomatic patients were older, male, have multivessel disease, with multimorbidity issues including diabetes, renal failure, lung disease and heart failure (all p<0.01). Over a median follow-up of 5±4 years, 1,970 patients died (18%). On multivariate Cox-proportional hazards modelling after adjusting for clinical and angiographic variables significant on univariate analysis, asymptomatic status was an independent predictor of long-term mortality (hazard ratio 1.39 95% CI 1.2-1.7, p<0.001; Figure). Conclusion: Results from this real-world registry suggest that over 1 in 10 patients undergoing PCI for SIHD are asymptomatic. Asymptomatic patients experienced higher adjusted risk of long-term mortality following PCI. As the primary goal of revascularization in SIHD remains angina relief, the appropriateness of PCI in the absence of symptoms warrants justification.