Abstract 4143127: Association of Serial Seattle Angina Questionnaire Assessments with Clinical Events in Chronic Coronary Disease: Insights from the ISCHEMIA Trial

Background: Cross-sectional Seattle Angina Questionnaire (SAQ) scores not only measure patients’ symptoms, function and quality of life, but are also associated with prognosis in chronic coronary disease (CCD). Yet, the prognostic significance of serial SAQ scores in the modern era is unknown, particularly after revascularization. Hypothesis: Serial collection of SAQ scores can provide updatable estimates of clinical risk in patients with CCD. Aims: To describe the association of serial SAQ Summary Scores (SAQ-SS) with the primary endpoint of the ISCHEMIA trial (CV death, MI, or hospitalization for heart failure, unstable angina, or resuscitated cardiac arrest), stratified by medical management and recent revascularization. Methods: Analyses were framed from the perspective of a clinician reviewing the SAQ-SS in clinic and seeking to understand whether the prior score, the current score, or the change was most prognostic of subsequent clinical events. Cox models were created using the 3-month, 6-month, and change between the 3- and 6-month SAQ-SS scores, individually, as well as those scores in combination to find the most prognostic permutation. Each model was adjusted for 17 potentially confounding covariates. We performed separate analyses for the conservative and invasive management cohorts. In the conservative group, we excluded those who underwent revascularization prior to their 6-month assessment. In the invasive group, we included only patients who were revascularized within the first three months. In both groups, we excluded patients with events prior to 6 months. Results: In both the conservatively managed (n=1965) and recent revascularization (n=1447) cohorts, unadjusted analyses estimated a 6-9% lower risk of clinical events over a median of 3.2 years for each 5-point increase in SAQ-SS score. The current SAQ-SS score was most strongly associated with clinical events, even after including the prior SAQ-SS score and all other covariates (Table). Conclusions: Routine clinical use of the SAQ provides an updatable measure of risk in patients with CCD—managed either medically or with revascularization—with the current SAQ-SS score demonstrating the strongest association with clinical events.