Differential Impact of Cardiometabolic Comorbidity Burden on Patient-reported Health-related Quality of Life across Acute Coronary Syndrome Subgroups having Undergone Percutaneous Coronary Intervention

Background: Patient-reported health-related quality of life (PHRQoL) has emerged as an important outcome following percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). While PCI improves survival and symptom burden, recovery may be influenced by ACS subtype and the presence of cardiometabolic comorbidities. This study evaluated longitudinal changes in PHRQoL following PCI and assessed the impact of diabetes mellitus (T2DM) and hypertension (HTN) on recovery trajectories. Methodology: This prospective observational cohort study included 119 patients with ACS (UA-n = 69; STEMI-n = 38; NSTEMI-n = 12) undergoing PCI at a tertiary care center. PHRQoL was assessed using the Duke Activity Status Index at 1 week, 1 month, and 3 months post-PCI. Patients were categorized according to comorbidity burden as no comorbidity, single comorbidity (T2DM or HTN), or dual comorbidity (T2DM and HTN). Multivariable linear regression analysis was performed to identify independent predictors of 3-month QoL. Results: Mean QoL improved significantly from 6.58 ± 2.71 at 1 week to 27.87 ± 7.34 at 1 month and 51.22 ± 10.11 at 3 months ( P < 0.001). STEMI patients demonstrated consistently lower QoL than UA and NSTEMI throughout follow-up. Increasing comorbidity burden was associated with progressively poorer recovery, with patients having dual comorbidity exhibiting the lowest 3-month QoL (34.5 ± 7.9). Recovery magnitude declined significantly with increasing comorbidity burden (partial η 2 = 0.32, P < 0.001). Multivariable regression identified comorbidity burden (β = −6.41, P < 0.001) and STEMI presentation (β = −7.82, P < 0.001) as independent predictors of lower 3-month QoL, whereas age and sex were not significant. Conclusions: PHRQoL improves substantially following PCI; however, recovery is significantly influenced by ACS subtype and cumulative cardiometabolic comorbidity burden. STEMI and the coexistence of diabetes and hypertension independently predict poorer functional recovery. Incorporating comorbidity burden into post-PCI risk stratification may facilitate targeted rehabilitation and improve patient-centered outcomes.