Residual angina occurs in 42.2% of patients after anatomic complete revascularization for chronic coronary disease

This randomized controlled trial enrolled 2588 participants randomized to invasive management for chronic coronary disease. The population consisted of symptomatic patients with baseline angina, defined by a Seattle Angina Questionnaire Angina Frequency score less than 100. Participants had no prior coronary artery bypass graft surgery and underwent anatomic complete revascularization within 90 days of randomization. The study setting location was not reported in the provided data.

The primary outcome assessed the frequency of residual angina after revascularization. This was defined as a Seattle Angina Questionnaire Angina Frequency score less than 100 within six months of randomization. Among the 436 participants who achieved anatomic complete revascularization, 184 individuals experienced residual angina. This represents an incidence of 42.2% in this specific subgroup.

Several secondary outcomes measured health status and functional limitations at six months. The Seattle Angina Questionnaire Quality of Life score was 70 plus or minus 20 in the residual angina group versus 83 plus or minus 20 in the group without residual angina. This difference had a p-value less than 0.001. The Seattle Angina Questionnaire Physical Limitation score was 84 plus or minus 20 versus 95 plus or minus 11, with a p-value less than 0.001.

Additional assessments included the Rose Dyspnea Scale score, which was 1 plus or minus 1.3 versus 0.4 plus or minus 0.8, with a p-value less than 0.001. Medication use for angina showed a statistically significant difference with a p-value of 0.006, indicating greater use in the residual angina group. Procedural data showed percutaneous coronary intervention was used in 88% of cases versus 80% for coronary artery bypass graft surgery, with a p-value of 0.03.

Long-term mortality outcomes were evaluated at five years. Five-year all-cause death and five-year cardiovascular death did not differ significantly between groups. Specific absolute numbers or p-values for these mortality endpoints were not reported. Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported in the available information.

A key limitation noted was that baseline characteristics were similar between those with and without residual angina. The study design does not explicitly distinguish between association and causation beyond the trial structure. Furthermore, the data does not explicitly distinguish between surrogate and clinical outcomes beyond the trial design. Funding sources and conflicts of interest were not reported.

Clinically, residual angina is common following anatomic complete revascularization for chronic coronary disease. The incidence exceeds 40% and is associated with reduced quality of life and greater antianginal medication use. However, this condition does not appear to increase the risk of death. Questions remain regarding the specific etiologies of residual angina and strategies to mitigate persistent symptoms in this population.