Recurrent angina is an ongoing challenge

Chronic angina may persist even after percutaneous coronary intervention (PCI).

Real world claims data
In a real-world study of US Commercial and Medicare claims data of patients who had undergone PCI*1

Patients with PCI admissions between 2008-2011 were identified from the Truven Health MarketScan® Commercial and the Medicare Supplemental Research claims databases. Angina or chest pain post-PCI was ascertained using medical diagnosis and procedure codes. Patients were followed up for 36 months.

Recurrent angina in clinicial trials
Angina at baseline versus 1 year post-PCI in patients randomized to receive PCI

ARTS, COURAGE, SYNTAX, FAME, AND BARI-2D trials†2-6

Baseline data represent the percentage of patients reporting angina at study baseline.

The BARI-2D trial enrolled patients with coronary artery disease, type 2 diabetes mellitus, and myocardial ischemia. This reflects a subset of patients with classic angina.
ARTS=Arterial Revascularization Therapies Study;
BARI-2D=Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes Trial;
COURAGE=Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Trial;
FAME=Fractional Flow Reserve Versus Angiography for Multivessel Evaluation;
SYNTAX=Synergy Between PCI With Taxus and Cardiac Surgery Trial.

Trial Descriptions
ARTS: Arterial Revascularization Therapies Study2
  • 1205 patients with multivessel coronary artery disease (CAD) were randomized to receive either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
  • All PCI patients were treated with bare metal stents
  • Patients were recruited between 1997 and 1998
COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation3
  • 2287 patients with objective evidence of myocardial ischemia and significant CAD were randomized to receive either optimized medical therapy (OMT) alone (n=1138) or OMT with PCI (n=1149)
  • OMT was defined as antiplatelet therapy, long-acting metoprolol, amlodipine, and isosorbide mononitrate, alone or in combination, along with either lisinopril or losartan and aggressive lipid-lowering therapy
  • Most PCI patients were treated with bare metal stents (31 patients received drug-eluting stents)
  • At median follow-up of 4.6 years, 32.6% of patients in the OMT group and 21.1% of patients in the PCI group had subsequent revascularization
  • Patients were recruited between 1999 and 2004
SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery4
  • 1800 patients with 3-vessel or left main CAD were randomized to undergo either CABG (n=897) or PCI with paclitaxel-eluting stents (n=903)
  • Angina was defined as a score of < 100 on the SAQ angina-frequency subscale
  • Patients were recruited between 2005 and 2007
FAME: Fractional Flow Reserve Versus Angiography for Multivessel Evaluation5
  • 1005 patients with multivessel CAD were randomized to undergo PCI with implantation of drug-eluting stents guided by angiography alone (n=496) or guided by FFR measurements in addition to angiography (n=509)
  • Patients were included in the study if they had multivessel coronary artery disease, which was defined as coronary artery stenosis of at least 50% of the vessel diameter in at least 2 of the 3 major epicardial coronary arteries, and if PCI was indicated
  • Patients were recruited between January 2006 and September 2007
BARI-2D: Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes Trial6
  • 2364 patients with type 2 diabetes mellitus, documented CAD, and myocardial ischemia were randomized to receive an initial strategy of either coronary revascularization and OMT or initial OMT with the option of subsequent revascularization
  • OMT included lifestyle management targeting smoking cessation, diet, weight loss, and regular physical exercise. Antianginal medication therapy included beta-blockers, calcium channel blockers, and long-acting nitrates
  • Nearly one-third of patients received a drug-eluting stent
  • Patients were recruited between 2001 and 2005
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References:
  1. Ben-Yehuda O, Kazi DS, Bonafede M, et al. Angina and associated healthcare costs following percutaneous coronary intervention: A real-world analysis from a multi-payer database. Catheter Cardiovasc Interv. 2016; 88(7):1017-1024.
  2. Serruys PW, Unger F, Sousa JE, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med. 2001;344(15):1117-1124.
  3. Boden WE, O’Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516.
  4. Cohen DJ, Van Hout B, Serruys PW, et al. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. N Engl J Med. 2011;364(11):1016-1026.
  5. Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213-224.
  6. Dagenais GR, Lu J, Faxon DP, et al; Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Study Group. Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type 2 diabetes mellitus and stable ischemic heart disease. Circulation. 2011;123(14):1492-1500.
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