“PCI reduces the [incidence of] angina attacks in the first 3 to 5 years. However, later there is no difference. Concerning long-term survival, there is also no difference. However, most of the studies were from the period of old-generation stents. The problem is that only 60% to 70% of patients will receive optimal medical treatment after PCI,” Dr. Manolis explained.
“Stents may be no better at 5 years, but that may be due to a new lesion; repeat stenting may be an option. Also, many patients prefer stent placement because it means [fewer] drugs and side effects,” Dr. Jerome noted.
Although healthy lifestyle changes are an important part of management, they depend on patient compliance for success. Aspects include smoking cessation, maintenance of a healthy weight and healthy diet, and regular exercise.
Patient compliance can be difficult to achieve, the authors write, citing a study of 208 post-PCI angina patients in which only 13.5% of patients participated in cardiac rehabilitation. At 1 year, only 8% of smokers had quit smoking, and less than 50% of patients were exercising regularly.
“Lifestyle changes are very important. Sometimes their effects are more important for controlling future risk than the drugs. However, many patients start with good intentions, and in about 1 or 2 months go back to their previous life. Very often this happens during holidays and vacations because they go off their diet,” Dr. Manolis pointed out.
“Winter can be a dangerous time for people who have stable angina if they go out to shovel snow. The holidays can also be dangerous, [but] not just because of changes in diet and routines. Holidays can be a time of emotional stress for many people,” Dr. Jordan added.
Key Takeaways for Primary Care Providers
There are enough treatment options to improve QOL for most patients, and reduce episodes of angina. Optimal management with minimal side effects can be achieved, and monitoring tools are available to improve communication.