Assessing the Prognostic Value of Serial Seattle Angina Questionnaire Scores in Chronic Coronary Disease.
Higher scores on the Seattle Angina Questionnaire are associated with a lower risk of cardiovascular events in patients with chronic coronary disease, suggesting that regular assessments could be beneficial.
Where it sits
this study against the rest of the bofanglutide corpusSummary and findings
This study evaluated the prognostic value of serial Seattle Angina Questionnaire Summary Scores (SAQ-SS) in patients with chronic coronary disease. The analysis included 3405 participants from the ISCHEMIA trial, comparing conservative management and invasive management strategies. Higher SAQ-SS scores were associated with a lower risk of cardiovascular events over a median follow-up of 3.2 years.
Abstract
<h4>Background</h4>Patient-centered prognostic assessment in chronic coronary disease is vital for treatment optimization. Although the Seattle Angina Questionnaire Summary Score (SAQ-SS) correlates with clinical outcomes, clinicians lack guidance on how to weigh prior, current, or changes in scores, and whether prognostic significance varies by revascularization strategy.<h4>Methods</h4>The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches; 2012-2019) was a global, multicenter, randomized controlled trial. This secondary analysis evaluated the prognostic value of serial SAQ-SS assessments. The SAQ-SS ranges from 0 to 100, with higher scores indicating better health status. To simulate routine clinical care, the follow-up in ISCHEMIA was equated to outpatient clinic visits-we defined the 3-month SAQ-SS as the prior score and the 6-month assessment as the current score in the clinic. Analyses were stratified by treatment strategy: conservative management and invasive management with revascularization. Cox proportional hazards models assessed the association of the prior score, the current score, and the change in scores with ISCHEMIA's primary composite end point (cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, and resuscitated cardiac arrest), adjusting for 17 clinical covariates.<h4>Results</h4>This analysis included 3405 participants (1965 in conservative management: 77.4% male, mean age 64.3 years±9.5; 1440 in invasive management: 77.6% male, mean age 64.0 years±9.4). Over a median follow-up of 3.2 years, 215 (11.0%) and 96 (6.7%) participants in the conservative and invasive cohorts, respectively, experienced the primary composite end point. Higher prior, current, and change SAQ-SS were each independently associated with a lower risk of cardiovascular events. In the conservative cohort, each 5-point increase in the current SAQ-SS was associated with a 7% lower risk of the primary end point (hazard ratio, 0.93 [95% CI, 0.90-0.96]); in the invasive cohort, the association was 9% (hazard ratio, 0.91 [95% CI, 0.86-0.96]).<h4>Conclusions</h4>In patients with chronic coronary disease, the most recent SAQ-SS is the strongest health status predictor of future cardiovascular events. Serial SAQ-SS assessments provide a practical, dynamic, and patient-centered approach for updating prognosis in chronic coronary disease management.<h4>Registration</h4>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
Background
This paper addresses the prognostic assessment in chronic coronary disease, focusing on the utility of the Seattle Angina Questionnaire Summary Score (SAQ-SS). Previous studies have shown a correlation between SAQ-SS and clinical outcomes, but there is limited guidance on interpreting changes in scores over time. Understanding the prognostic significance of these scores can aid in treatment optimization.
Methods
This analysis utilized data from the ISCHEMIA trial, a global, multicenter, randomized controlled trial conducted from 2012 to 2019. The study population included 3405 participants, with 1965 receiving conservative management and 1440 undergoing invasive management. The primary outcome was a composite of cardiovascular death, myocardial infarction, hospitalization for unstable angina, heart failure, and resuscitated cardiac arrest, assessed using Cox proportional hazards models.
Results
Over a median follow-up of 3.2 years, 215 participants (11.0%) in the conservative management group and 96 participants (6.7%) in the invasive management group experienced the primary composite endpoint. Higher prior, current, and change SAQ-SS scores were independently associated with a lower risk of cardiovascular events. Specifically, in the conservative cohort, each 5-point increase in the current SAQ-SS was linked to a 7% lower risk of the primary endpoint (hazard ratio, 0.93 [95% CI, 0.90-0.96]). In the invasive cohort, the association was 9% (hazard ratio, 0.91 [95% CI, 0.86-0.96]).
Interpretation
The findings suggest that higher SAQ-SS scores are associated with a reduced risk of cardiovascular events, which aligns with previous literature on the importance of patient-reported outcomes. However, the clinical significance of the observed hazard ratios may be modest, particularly given the potential for confounding factors. Limitations such as the secondary analysis nature and the follow-up duration may affect the robustness of the conclusions drawn.
Key findings
- 3405 participants included in the analysis.
- 11.0% of participants in conservative management experienced the primary composite endpoint.
- 6.7% of participants in invasive management experienced the primary composite endpoint.
- Each 5-point increase in the current SAQ-SS was associated with a 7% lower risk of the primary endpoint in the conservative cohort (hazard ratio, 0.93 [95% CI, 0.90-0.96]).
- In the invasive cohort, each 5-point increase in the current SAQ-SS was associated with a 9% lower risk of the primary endpoint (hazard ratio, 0.91 [95% CI, 0.86-0.96]).
Limitations
- Secondary analysis of a randomized controlled trial.
- Follow-up duration of 3.2 years may not capture long-term outcomes.
- Potential confounding factors not fully accounted for.