Comparative Evaluation of Long-Term Clinical Outcomes and Quality of Life After Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Patients with Chronic Coronary Syndrome

Abstract

Objectives: Chronic Coronary Syndrome (CCS) remains a major cause of global morbidity and mortality. Although Percutaneous Coronary Intervention (PCI) is a well-established treatment for improving symptoms in obstructive coronary artery disease, its long-term effectiveness in enhancing Quality of Life (QoL) compared with Optimal Medical Therapy (OMT) remains uncertain. To assess and compare the long-term clinical outcomes and QoL in CCS patients treated with PCI versus OMT. Methodology: This ambispective cohort study was conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar, from June 2024 to June 2025. A total of 120 patients aged 40–80 years were included, equally divided into PCI and OMT groups. Functional capacity and QoL were measured using the Duke Activity Status Index (DASI) and Seattle Angina Questionnaire (SAQ) at baseline, six months, and twelve months. Clinical outcomes included mortality, major adverse cardiovascular events (MACE), and repeat revascularization. Results: The mean DASI and SAQ scores showed no statistically significant difference between PCI and OMT groups (DASI: p = 0.85; SAQ: p = 0.69). The MACE rate was slightly lower in the PCI group (8%) compared to OMT (12%), while repeat revascularization rates were 10% and 15%, respectively. Mortality rates were comparable (PCI: 3%; OMT: 4%). Both groups demonstrated mild improvement in QoL and functional capacity over time, but the inter-group differences were not significant. Conclusion: The findings suggest that PCI and OMT provide comparable long-term benefits in managing CCS, with similar improvements in functional capacity, QoL, and clinical outcomes. OMT remains an effective and less invasive alternative to PCI for stable CCS patients, emphasizing the need for individualized treatment decisions based on patient characteristics and risk factors.