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The economic and human burden of Coronary Artery Disease (CAD) is substantial. Although Percutaneous Coronary Intervention (PCI) can reduce the morbidity and mortality associated with CAD, recent clinical trial data indicate that up to a third of patients experience angina in the year after PCI. Given the selective inclusion criteria of most trials, results cannot always be extrapolated to all patients treated. This study aimed to use real-world data to explore the incidence of post PCI angina and chest pain and subsequent costs to secondary care providers in England.
Hospital Episode Statistic (HES) data were used to identify adults who had undergone PCI between March 1st 2011 – December 31st 2011 (index event) in England. Patients with 3 years of post-index event data were included in the analysis. Clinically significant outcomes were defined as presentation to hospital departments with angina and chest pain. Patients were identified from data extracted from HES for inpatient admissions, outpatient consultations and accident and emergency visits associated with relevant World Health Organisation International Disease Codes (WHO ICD10). Preliminary analyses of the financial burden associated with post PCI angina and chest pain were conducted using Payment by Results coding in the HES data set. Cost estimates were presented in 2013/14 prices based on the Hospital and Community Health Services index (HCHS).
32,492 met study inclusion criteria (mean age 64 years [SD 11.8], 74% male). The cumulative incidence of angina/chest pain was 23% (n= 7,473) at 12 months, 31% (n= 10,199) at 24 months and 37% (n= 11,940) at 36 months following PCI. It is estimated that bootstrapped cumulative mean costs to the secondary care provider were significantly higher at 12 months in those with angina/chest pain at £ 10,215, 95% CI [£10,083, £10,348] vs. £6,552, 95% CI [£6,503, £6,601] for those without. Significant cost differences persisted to 36 months post PCI £ 14,754 95% CI [£14,571 £14,936] for those with angina vs. £ 8,407, 95% CI [£8,324, £8,489] for those without.
Our analysis, using real-world data, suggests that angina and chest pain are common following PCI. Moreover, incidence increased over time, to the extent that at 36 months over a third of patients experienced angina/chest pain. This is important because angina and chest pain have a detrimental impact on patients health related quality of life. In addition our analysis indicates that resource consumption is considerably greater in those affected. As angina/chest pain following PCI are associated with a human and economic burden, therapeutic strategies, or interventions resulting in a lower incidence of angina and chest pain post PCI, would have the potential to reduce the financial burden on the NHS.
CORONARY: PCI Outcomes
Angina, Complication, Percutaneous coronary intervention