C-34 | Quality of Life Assessment in Patients with Chronic Coronary Syndrome Following Percutaneous Coronary Intervention versus Optimal Medical Therapy: A Meta-analysis of Randomized Controlled Trials

Previous studies have focused on evaluating the effect of percutaneous coronary intervention (PCI) on hard outcomes when compared to optimal medical therapy (OMT) in patients with chronic coronary syndrome (CCS). This meta-analysis seeks to assess the effect of PCI plus OMT on quality of life compared to OMT alone in patients with CCS. Cochrane Central Registry of Controlled Trials, PubMed, Embase, and clininalTrials.gov were searched for studies published up to December 2023. The primary outcome was quality of life measured with Seatle Angina Questionnaire or its equivalents. Secondary outcomes were freedom from angina, angina frequency, functional capacity, and need for revascularization. The Duke Activity Status Index was used to assess functional capacity when reported. Fixed-effect model was used for data analysis if I2 statistics <50%; otherwise, the random-effect model was used. Sensitivity analysis was performed by alternate removal of a trial from the study to assess its impact on the result. Seventeen randomized controlled trials that enrolled 13,588 patients satisfied our inclusion criteria with an average age of 62.3±10 years and followed for 3 years. PCI with OMT improved quality of life with standardized mean difference (SMD) of 0.27 ([95% CI, 0.14-0.40]; P <0.0001; I2 = 83%) and 0.21 ([95% CI, 0.12-0.30]; P <0.00001; I2 = 70%) at 6 months and 1 year respectively. PCI with OMT was also associated with significant improvement in freedom from angina (1.17 [95% CI, 1.11-1.24]; P <0.00001; I2 = 46%), angina frequency (0.25 [95% CI, 0.20-0.30]; P <0.00001; I2 = 0%), and functional capacity (0.21 [95% CI, 0.12-0.31]; P <0.0001; I2 = 58%) at 6 months and persisted throughout the 3 years of follow-up. However, there appears to be a reduction in this effect with time. There was also a trend towards increased revascularization in the OMT group compared to the PCI at 3 years, but this was not statistically significant (0.70 [95% CI, 0.48-1.01]; P =0.06; I2 = 88%). In this meta-analysis, PCI plus OMT was associated with better quality of life, freedom from angina, angina frequency, and improved functional capacity compared to OMT alone in patients with CCS. However, this benefit appears to attenuate with time.