https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article Effect of Percutaneous Coronary Intervention on Quality of Life among Coronary Artery Disease Patients in Erbil City ABSTRACT Background and objective: Quality of life is acknowledged as a vital outcome of healthcare measures, mostly in persons with heart disease. The main purpose of percuta- neous coronary intervention is improving patients' quality of life. This study aimed to evaluate the effect of percutaneous coronary intervention on the quality of life of coro- nary artery disease patients at Surgical Specialty Hospital-Cardiac Center in Erbil City. Methods: A pre-post study design was conducted to evaluate the quality of life of 100 patients with coronary artery disease before undergoing percutaneous coronary interven- tion, and three months after the performed percutaneous coronary intervention, it was conducted from January 2022 until December 2022. The quality of life data was assessed through the Short Form-36 health status survey. It consists of 36 questions that measure eight health concepts divided into two dimensions: the physical and mental aspects. The highest score indicates better quality of life. Data were analyzed using the Statistical Pack- age for the Social Sciences (Version 26). Results: Most of the study participants were males with Mean and Standard Deviation of age 47.9±6.8. The highest percentage were married, able to read and write, self- employed, and hasn’t previous percutaneous coronary intervention. The results showed that patients who underwent percutaneous coronary intervention significantly improved their quality of life after performing percutaneous coronary intervention in the following subdomains of physical component summary (physical functioning, role-physical, general health) and (social functioning), P-value <0.05. While in subdomains of mental component summary (bodily pain, vitality, role-emotional and mental health) there were no statisti- cally significant differences P-value >0.05. Conclusion: The study concluded that overall quality of life significantly improved after performing percutaneous coronary intervention for coronary artery disease patients, mostly in the physical aspect compared with the mental aspect. Keywords: Percutaneous Coronary Intervention; Quality of Life; Coronary Artery Disease. Chnar Salahaddin Qadir; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: : chnar.qadir@hmu.edu.krd) Yousif Mohammed Younis; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq 01 Received: 20/01/2023 Accepted: 29/03/2023 Published: 30/05/2025 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:chnar.qadir@hmu.edu.krd?subject=chnar.qadir@hmu.edu.krd mailto:chnar.qadir@hmu.edu.krd?subject=chnar.qadir@hmu.edu.krd mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article Cardiovascular diseases (CVDs) are the main causes of death worldwide. A predict- able 17.9 million persons died from CVDs in 2019, representing 32% of overall deaths globally >75% of coronary artery disease deaths happen in low and -middle- income countries [1]. According to the lat- est WHO data published in 2020, Coronary Artery Disease (CAD) deaths in Iraq reached 36,594 (24.98%) of total deaths in 2021. The age-adjusted death rate is 227.26 per 100,000 of the population which ranking Iraq 23rd in the world [2]. The cardiac and metabolic indicators carry a predisposition to a chronic disease, such as heart disease, it can comprise a single factor or can be associated with metabolic syndrome. Early coronary intervention is crucial to prevent cardiovascular complica- tions [3]. Percutaneous Coronary Interven- tion (PCI) is nowadays the well-known gold standard treatment; it should be conduct- ed along with other therapeutic methods for secondary prevention. PCI offers nu- merous advantages together, which in- clude fewer mortality rates, faster medical improvement, decreased disability, lower risk of new cardiac events, slower the de- velopment of CAD, and better quality of life [4]. In Iraq, although precise statistics are not available, nonetheless, with the prevalence increasing, the number of pa- tients with coronary artery disease, and a great number of patients are daily under- going PCI, in accordance with statistical facts from the Surgical Specialty Hospital- Cardiac Center in Erbil City. The number of PCI was 2526 in 2020 [2]. Patients with CVD experience numerous physical symp- toms, including fatigue, dyspnea, or chest pain, which affect their physical, emotion- al, and social well-being with significant impairment in quality of life (QoL) [5]. Dur- ing the past decades, PCI has been one of the fastest-growing therapeutic coronary interventions for patients with narrowed/ blocked coronary arteries and improves the quality of life [6]. Quality of life is recognized as a significant outcome measure of health care, particularly in patients with long-lasting diseases such as coronary artery disease [7]. Poor quality of life has been identified as an independent risk factor for mortality and major cardiac events in patients with cardiovascular disease [8].For patients with CAD who underwent PCI, quality of life is an important outcome indicator, along with death and recurrence rates [9]. All things considered, this study aimed was to evaluate the impact of percutaneous coronary intervention on quality of life through the used of the SF-36 health survey in Erbil City in the Kurdistan region of Iraq. A pre-post design study was conducted at Surgical Specialty Hospital-Cardiac Center after taking ethical approval from the ethical committee (code no. 140) and Date Sep 2021, at College of Nursing/Hawler Medical University, Erbil, Kurdistan region of Iraq from Jan 2022 to Dec 2022, on 100 coronary artery diseases (CAD) patients before undergoing percutaneous coronary intervention, after 3 months who performed percutaneous coronary intervention were carefully chosen with the purposive sampling method according to the inclusion criteria of the study. The participants of this study were adult patients diagnosed with coronary artery disease, which needed percutaneous coronary intervention, which was confirmed by coronary angiography, and were conscious, while; the exclusion criteria were patients who had communication problems and coronary artery bypass graft. The questionnaire consisted of demographic data and clinical 02 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article (0.96-1.0), and high (>1.0) [13,14]. Regard- ing the echo study, left ventricular ejec- tion fraction (LVEF) is classified by the American College of Cardiology (ACC) as hyper dynamic = LVEF (greater than 70%); normal LVEF 50% to 70% (midpoint 60%); mild dysfunction LVEF 40% to 49% (midpoint 45%); moderate dysfunction LVEF 30% to 39% (midpoint 35%); severe dysfunction = LVEF less than 30% [15]. The standardized quality of life (QoL) as- sessment tool was a validated and reliable short form-36 (SF-36) survey and is a com- mon multidimensional tool containing eight domains, called physical functioning (PF), role-physical (RP); bodily pain (BP); general health (GH); role-emotional (RE); vitality (VT); social functioning (SF); and mental health (MH). The scores are gath- ered into two aspects: the Physical Com- ponent Summary (PCS) and the Mental Component Summary (MCS). The overall scores range from zero to 100 with higher scores representing better QoL. There is a different Likert scale used in the Quality of Life (SF-36) Health Survey. In regard to the transformation score, scores are convert- ed to a 0-100 scale. The lowest score indi- cates functional limitation, severe social and role disability, and distress. High scores indicate the absence of limitations and disability [16,17]. Patients were in- formed and verbally consented to the par- ticipation of the study, also explaining the purpose of this study before starting the interview, and were told that their partici- pation would be voluntary. Patients who evaluate the effect of PCI on QoL by changing the outcome variables of the study, in the post-test, CAD patients were taken again after three months of PCI. Sta- tistical data were analyzed using (SPSS Version 26). Mean and standard deviation (SD) were accessible for measurable varia- bles; frequencies and percentages were given for categorical data. A paired t-test data such as (age, gender, level of educa- tion, marital status, occupation, cigarette smoking, family history, previous history of PCI, duration of diagnosis of heart disease) and cardiac and metabolic indicators such as blood pressure, which was classified by the World Health Organization (WHO) as normal < 120/<80 mmHg; pre- hypertension: >120-139/85-89 mmHg; stage 1 hypertension 140-159/90-99 mmHg; stage 2 hypertension: >160/>100 mmHg[10]. Regarding biomedical lipid val- ues classified based on the American Dia- betes Association (ADA) as total cholester- ol / (mg/dl) (High ≥200, Low <200), triglyc- erides (mg/dl) (High ≥150, low <150), low- density lipoprotein (LDL) (mg/dl) (high ≥100, low<100), high-density lipoprotein (HDL) (mg/dl) High ≥ 45, low <45) [11]. Gly- cated hemoglobin (HbA1c) is a medical term that refers to the typical levels of blood sugar in a person with type 2 diabe- tes mellitus, which is classified by the American Diabetes Association (ADA), Good glycemic control HbA1c (≤7%) and poor glycemic control HbA1c (>7%) [12]. Body mass index (BMI): It was calculated as the weight (kg) divided by height squared (m2). In addition, body mass index was categorized according to the World Health Organization (WHO) as under- weight (< 18.5), (18.5-24.9) normal, and overweight (25-29.9). Obesity class I (30.0– 34.9) class II (35.0–39.9) Extreme obesity class III (40.0) [13,14]. Mean waist circum- ference (WC) ranges between populations from 83-98 cm in men and from (78-91) cm in women. Mean hip circumference (HC) ranged from 94-105cm in men and from (97-108) cm in women, respectively, and the World Health Organization classifies the risk of being affected by weight-related health conditions according to the Waist- Hip Ratio (WHR). For women: low (≤ 0.80), medium (0.81-0.85), and high (>0.86). While for men, low (≤ 0.95), medium 03 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article was used to compare subdomain and over- all quality of life. The Kolmogorov-Smirnov test is used to evaluate the assumption of normality. P values less than 0.05 were considered significant. Table 1 shows the demographic and medi- cal data of the study sample; the age of participants ranged from 33-60 years, and the mean age was 47.90 years (SD = 6.8); nearly half the percentage 47% was within the age group 47-53 years, and 66% of the sample was male. In regard to the level of education, less than half the percentage 42% were able to read and write, and a higher proportion 88% were married. Re- garding occupation 38% of the self- employed, in relation to cigarette smoking 10% were current smoker, 70% of patients had smoked less than 1 pack/day for less than 10 years. More than half a percent- age 55% of patients does not have a family history of heart disease. The finding of the study shows 89% of patients had not un- dergone PCI previously; also, 49% of pa- tients had been diagnosed with coronary artery disease (CAD) between one and three years. 04 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT Table 1: Demographic and clinical data of the study participants Variables n=(100) F (%) Age group (year) 33-39 13(13) 40-46 25(25) 47-53 47(47) 54-60 15(15) M±SD 47.90±6.8 Gender Male Female 66(66) 34(34) Level of education Able to read and write Primary School Secondary School Institute graduation 42(42) 27(27) 19(19) 12(12) Marital status Married Single Widowed Divorced 88(88) 3(3) 6(6) 3(3) Occupation Governmental employed Self-employed Unemployment Housewife 26(26) 38(38) 12(12) 24(24) Cigarette smoking Non-smoker 57(57) Current smoker 10(10) Ex-smoker 33(33) Number of cigarettes per day Less than 1 pack/day More than 1 pack/day 7(70) 3(30) Duration of cigarettes smoking Less than 10 years More than 10 years 7(70) 3(30) Family history No 55(55) Yes 45(45) Previous of PCI No 89(89) Yes 11(11) Duration diagnosis of heart diseases Less than 1years 35(35) 1-3 years 49(49) More than 3 years 16(16) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article 05 it was (43%) of patients’ HDL more than 45 mg/dL. Relating to glycemic control, it was shown before PCI (65%) of patients had poor glycemic control (HbA1c ≥7%) compared to post- PCI nearly half of the patients had their HbA1c change to good glycemic control (HbA1c <7%). Further- more, concerning body mass index (BMI), 52% of patients were overweight. While in post-education, 23% was within nor- mal body weight. Concerning waist to hip ratio (WHR) male, and female patients 26%, 19% respectively, had median WHR, while in post-PCI, it changed to 24%,17% consequently. In regard, to left ventricu- lar ejection fraction (LVEF) 40% of pa- tients have moderate LVEF, however, in post-coronary intervention, a higher per- centage 41% of patients had mild LVEF [in Table 2]. Table 2 shows cardiac and metabolic indi- cators of CAD patients concerning hyper- tension in the pre-test, more than half the percentage 69% of the patients were stage 1 hypertension, while compared to post- PCI, it was reduced to 30%. Regarding total cholesterol, at baseline, most of the pa- tients 67% had their total cholesterol was more than (200 mg/dL). While in post- percutaneous coronary intervention more than half the pre-test (59%) of patients of a total cholesterol less than (200 mg/dL). Re- garding triglycerides in the pre-PCI 58% of patients, triglycerides were more than 150 mg/dL, while in post-PCI, it was 53%. In rel- ative terms, low-density lipoprotein (LDL) at baseline (64%) of the patient’s LDL was more than 100 mg/dL after coronary inter- vention dropped to (58%). Moreover, the highest percentage 67% of patients HDL was less than 45mg /dl, whereas inpost- Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2: Cardiac and metabolic indicators of CAD patients of before and after PCI Cardiac and metabolic indicators Pre PCI F(%) Post PCI F(%) Hypertension BP normal (120/<80 mmHg) 3(3) 7(7) Pre-hypertension (>120-139/85-89 mmHg) 10(10) 41(41) Hypertension stage 1(140-159/90-99 mmHg) 69(69) 30(30) Hypertension stage 2 (>160/>100 mmHg) 18(18) 12(12) Total-cholesterol (TC) Low (<200) mg/dL 33(33) 59(59) High (≥200) mg/dL 67(67) 41(41) Triglycerides (TG) Low (<150) mg/dL 42(42) 47(47) High (≥150) mg/dL 58(58) 53(53) Low-density lipoprotein (LDL) Low (<100) mg/dL 36(36) 42(42) High (≥100) mg/dL 64(64) 58(58) High-density lipoprotein (HDL) Low (<45) mg/dL 67(67) 57(57) High (≥45) mg/dL 33(33) 43(43) Glycated hemoglobin (HbA1c) Good control <7 % 35(35) 47(47) Poor control ≥ 7 % 65(65) 53(53) Body mass index (BMI) Normal (18.5-24.9) 17(17) 23(23) Overweight (25-29.9) 52(52) 40(40) Obese (≥30) 31(31) 37(37) Waist-hip ratio of males (WHR) Low (<0.95) 17(17) 12(24) Medium (0.95-1.0) 26(26) 24(24) High >1.0 23(23) 30(30) Waist hip ratio of females (WHR) Low ≤ 0.80 6(6) 3(3) Medium 0.81-0.85 19(19) 17(17) High >0.86 9(9) 14(14) Left ventricular ejection fraction (LVEF) Normal (50% to 70%) 24(24) 29(29) Mild (40% to 49%) 36(36) 41(29) Moderate (30% to 39%) 40(40) 30(30) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article (39.90±15.70 to 40.60 ±14.31, P-value =0.753), in role-emotional (39.56±14.05 to 41.33±31.11, P-value =0.630), in mental health (39.67±17.21 to 40.52±11.91, P- value =0.815). Finally, the total mean score in the aspect of physical component sum- mary (PCS) significantly raised from (39.57±12.62 to 45.49±11.63, P-value <0.001) compared to no significant in men- tal component summary (MCS) (38.69±11.17 to 40.99±9.37, P-value =0.103), in term of overall mean score quality of a life a highly significant im- provement after performing percutaneous coronary intervention (39.13±9.61 to 43.24±8.07, P= 0.001). cohort study from 2 large academic medi- cal centers in Massachusetts that included patients who experienced a myocardial infarction, most of the patients were 45% years of ages between 44-50 years [18,19]. Also, findings agree with a study done by Huber et al., who determined the psychometric properties of the German HeartQoL, which was done among (n=489) patients with heart diseases from five cen- ters in Austria and Switzerland to validate 06 Table 3 illustrates the average mean score of quality of life of coronary artery disease patients before and after undergoing per- cutaneous coronary intervention. Accord- ing to this table, the mean score sub- domains quality of life, in physical func- tioning were increased significantly (39.70±11.99 to 44.90±10.47, P-value =0.003), in role-physical (40.00±12.76 to 48.75±14.57, P-value =0.048), in general health (40.0±17.38 to 44.21±12.63, P- value =0.03), and social functioning (35.63±13.58 to 41.50±18.37, P-value =0.024). While no statistically significant difference in bodily pain (38.58±13.98 to 44.10±16.23, P-value =0.128), vitality The present study findings demonstrate that the highest percentages were ages ranging between 47-53 years old, a high proportion of them were male, married, able to read and write, and the majority of patients self-employed. It also shows most of coronary artery disease patients were non-smokers, with no family history and coronary artery disease duration be- tween 1 and 3 years. The current study finding was supported by a retrospective Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3: Comparison mean score of quality of life (SF-36) before and after PCI SF-36 Domains Mean + SD Mean difference t-test P-Value Pre PCI Post PCI Physical functioning 39.70±11.99 44.90±10.47 -5.20 -3.10 0.003 Role-physical 40.00±12.76 48.75±14.57 -8.75 -2.00 0.048 Bodily pain 38.58±13.98 44.10±16.23 -5.52 -1.53 0.128 General health 40.00±17.38 44.21±12.63 -4.21 -2.17 0.033 PCS 39.57±12.62 45.49±11.63 -5.92 -0.32 <0.001 Vitality 39.90±15.70 40.60±14.31 -0.70 -0.32 0.753 Social functioning 35.63±13.58 41.50±18.37 -5.87 -2.29 0.024 Role-emotional 39.56±14.05 41.33±13.11 -1.66 -0.48 0.630 Mental health 39.67±17.21 40.52±11.91 -0.96 -0.24 0.815 MCS 38.69±11.17 40.99±9.37 -2.30 -1.65 0.103 Overall quality of life 39.13±9.61 43.24±8.07 -4.11 -3.58 0.001 PCS-Physical Component Summary; MCS-Mental Component Summary Discussion https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article and hypertriglyceridemia. [7]. Relative to LDL, most of the patients had high LDL, and low HDL. The results are supported by the study done in Baghdad City which most participants have dyslipidemia [22]. Con- cerning BMI, more than half a percentage was overweight. Also, it is agreed by a study that that revealed that most CAD patients were more likely to have a higher BMI [23]. In regard to glycemic control, it was shown before PCI most of the patients had poor glycemic control, the present study agrees with the study by Dzhun et al, which reported that a higher proportion of patients had HbA1c >7 %) [24]. In addition to cigarette smoking, being overweight, hypercholesterolemia, hypertension, dia- betes, and BMI significantly impact the quality of life [21,25]. The present study was supported by a study done by Pasdar et a l, which found that the majority of study participants had a higher waist-hip ratio (WHR) than normal [26]. Concerning left ventricular ejection fraction (LVEF), the current study was a supported study that shows the LVEF pre-PCI was 52% between (40-50%) [15]. The overall quality of life better improved in physical aspects, it was similar to previous studies [17,27] shown that the effect of QoL was observed in most subdomains and was significant with regard to physical functioning, general health, social functioning and role-physical. Moreover, the current findings agree with prior studies conducted on a convenience sample of 119 Palestinian patients in 2020, using the Short Form-36 Health Survey ap- plied 1 year after the coronary artery sur- gery [16]. Also, it came with study [28] that evaluated the quality of life (QOL) after percutaneous coronary intervention (PCI) using a short form health survey (SF- 36) questionnaire at a tertiary care hospi- tal in Pakistan. A total of 433 adult patients who underwent PCI, showed that the high- est mean score was reported for PF, RE, the German version of the HeartQoL, who revealed that most of the patients were married (71.1%) and did not complete school (62.6%) and about half of them were self-employed (52.1%) [7]. Moreo- ver, the study results come along with a descriptive, cross-sectional study on 210 patients with coronary artery disease in South Korea [20] to investigate the factors influencing HRQoL in patients with coro- nary artery disease who had received PCI. Most of the patients were married. Fur- thermore, the results of the present study agree with a cross-sectional study con- ducted on 106 patients referred to a cardi- ac clinic who attended the follow-up visit 3 months after coronary angioplasty during 2015-2016 in Rasht, Iran. Most of the pa- tients were married (71.7%) nonsmokers (67%) no family history of heart disease; the majority of them had coronary artery disease duration between 1-3 years [21]. Concerning cardiac and metabolic indica- tors, the study findings found more than half a percentage of patients were stage 1 hypertensive. The current result findings are similar with study done by Gasecka et al., who evaluated HRQOL in patients after the first AMI treated in a reference cardi- ology centre in Poland and assessed which clinical variables affect HRQOL through Short Form (SF) 36 after AMI in patients undergoing PCI, who found that most of the 61% of patients had hypertension [15]. Also, the findings are compatible with a previous study on health-related quality of life (HRQL) among 305 patients with angi- na (N = 101), myocardial infarction (N = 123), or ischemic heart failure (N = 81) in Austria and Switzerland using German ver- sions of the HeartQoL, and the Short Form -36 Health Survey (SF-36) done by Huber et al., who show that more than one-half of the patients had hypertension. Regard- ing lipid profile tests, the highest percent- age of patients had hypercholesterolemia 07 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.01 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article [3] Huang RC, Prescott SL, Godfrey KM, Davis EA. Assessment of cardiometabolic risk in children in population studies: underpinning developmental origins of health and disease mother-offspring cohort studies. Journal of nutritional science. 2015;4:e12. Published 2015 Apr 10. doi:10.1017/jns.2014.69. [4] Smith SC, Jr Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ ACCF Secondary Prevention and Risk Reduc- tion Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiol- ogy Foundation [published correction ap- pears in Circulation. 2015 14;131 (15):e408]. Circulation.2011;124(22):2458- 2473. doi:10.1161/CIR.0b013e318235eb4d. [5] Moryś, J. M., Bellwon, J., Höfer, S., Rynkie- wicz, A., & Gruchała, M. Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure. Archives of medical sci- ence. 2016;12(2), 326–333. https:// doi.org/10.5114/aoms.2014.47881 [6] Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V et al. ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio- Thoracic Surgery (EACTS)Developed with the special contribution of the European Associ- ation of Percutaneous Cardiovascular Inter- ventions (EAPCI). European Heart Journal. 2014;35 (37):2541-2619. doi:10.1093/ eurheartj/ehu278. [7] Huber A, Oldridge N, Benzer W, Saner H, Höfer S. Validation of the German HeartQoL: a short health-related quality of life ques- tionnaire for cardiac patients. Quality of life research : an International Journal of quality of life aspects of treatment, care and reha- bilitation. 2020;29(4), 1093–1105. https:// doi.org/10.1007/s11136-019-02384-6 [8] Conradie A, Atherton J, Chowdhury E, Duong M, Schwarz N, Worthley S, Eccleston D. “Health-Related Quality of Life (HRQoL) and the Effect on Outcome in Patients Presenting with Coronary Artery Disease and Treated with Percutaneous Coronary Intervention (PCI): Differences Noted by Sex and Age.” Journal of clinical medicine. 2022;11,17 5231. 5 Sep. 2022, doi:10.3390/ jcm11175231 and RF were significantly higher in overall score, mostly in PCS than in the MCS score. An increasing trend, with respect to patients’ perception of QoL compared to one year ago. Furthermore, the current study was a come along with follow-up a study done In Japan on a total of 118 pa- tients treated with percutaneous coronary intervention (PCI) who revealed an im- provement in the aspect of physical func- tioning in relation to quality of life was seen at 6 months after discharge [29]. To sum up, the quality of life of CAD pa- tients who underwent PCI improved better in general specifically in the domains of general health, physical functioning, social functioning, and role physical. Also, the findings revealed that cardiometabolic risk indicators improved after percutaneous coronary intervention. The authors would like to thank the per- sonnel of the Surgical Specialty Hospital- Cardiac Center in Erbil City for their coop- eration. The author reports no conflict of interests. The authors (s) report no funding support. [1] World Health Organization. Cardiovascular diseases (CVDs). Key facts Cardiovascular diseases (2021). 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