How patient-reported physical and mental health affect coronary artery disease outcomes
Self-reported low physical or mental health can lead to worse long-term outcomes among patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), according to a new analysis published in Circulation.[1]
“Assessment of preprocedural physical and mental health enables a comprehensive evaluation of a patient’s tolerance to any proposed invasive procedures as well as post-procedural treatments including rehabilitation,” wrote first author Masafumi Ono, MD, with Amsterdam UMC in the Netherlands, and colleagues. “Past studies have demonstrated that physical limitations or deterioration in mental health are associated with poorer prognosis in patients with CAD, including those undergoing PCI or CABG. Therefore, these assessments are potentially important when selecting the optimal mode of revascularization.”
Ono et al. performed a subanalysis of the SYNTAXES study, tracking data from more than 1,600 patients who underwent PCI or CABG for left-main CAD or 3-vessel disease (3VD). The median follow-up period was 11.2 years.
All patients completed questionnaires about their physical and mental status before the procedure. Patients were excluded from this analysis if their questionnaire answers were not sufficient enough for the authors to make an evaluation.
Overall, the group found that higher physical and/or mental health scores were associated with lower all-cause mortality rates after 10 years.
Also, among patients with high physical and mental health scores, 10-year mortality was 30.5% for PCI patients and 12.2% for CABG patients. Among patients with low physical health and mental health scores, however, there was “no significant difference” in 10-year mortality.
The authors detailed the impact these findings could have on patient care, particularly when it comes to choosing between PCI and CABG among patients with complex CAD.
“Good preprocedural physical and mental health is required for patients undergoing CABG, who not only have to recover from surgery but also have to adequately adhere to the rehabilitation process … and in those patients, CABG may be a better modality of revascularization than PCI to improve long-term prognosis,” they wrote. “In other words, among patients with complex CAD, moderately/severely impaired physical or mental health may correlate with frailty, which is known to have an adverse effect on outcomes after CABG, and therefore, in these patients, PCI may be a good alternative to CABG.”
The group also highlighted the importance of patient-reported physical health and mental health scores, writing that they offer “a more narrative and comprehensive assessment” of the patient.
“Therefore, together with objective risk scores, these patient self-assessments should be shared with the Heart Team to facilitate a holistic understanding of the individual patient, facilitating the selection of a personalized treatment strategy not only for the index treatment but also for additional interventions during the follow-up phase,” they wrote.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.