Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease

被引：4

作者：

Atreya, Auras R. ^{[1
,2
]}

Sivalingam, Senthil K. ^{[1
]}

Arora, Sonali ^{[1
,2
]}

Kashef, Mohammad Amin ^{[1
,2
]}

Fitzgerald, Janice ^{[3
]}

Visintainer, Paul ^{[4
]}

Lotfi, Amir ^{[1
,2
]}

Rothberg, Michael B. ^{[5
]}

机构：

[1] Baystate Med Ctr, Dept Internal Med, Div Cardiovasc Med, Springfield, MA USA

[2] Tufts Univ, Sch Med, Dept Internal Med, Boston, MA 02111 USA

[3] Baystate Med Ctr, Dept Internal Med, Fac & Resident Dev, Springfield, MA USA

[4] Baystate Med Ctr, Div Epidemiol & Biostat, Springfield, MA USA

[5] Cleveland Clin, Inst Med, Ctr Value Based Care Res, Cleveland, OH 44106 USA

来源：

CLINICAL CARDIOLOGY | 2016年 / 39卷 / 04期

关键词：

PERCUTANEOUS CORONARY INTERVENTION; ASSOCIATION TASK-FORCE; ARTERY-DISEASE; MYOCARDIAL-INFARCTION; THERAPY; REVASCULARIZATION; APPROPRIATENESS; METAANALYSIS; ANGIOGRAPHY; GUIDELINES;

D O I：

10.1002/clc.22510

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundCompared with medical therapy, percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction in patients with stable angina. Therefore, PCI should be guided by refractory anginal symptoms and not just lesion characteristics. HypothesisWe hypothesized that angiographic lesion characteristics and stress test results would have a greater role in the decision to proceed with PCI than would symptom severity. MethodsWe performed a retrospective cohort study of patients undergoing elective cardiac catheterization and possible PCI at an academic medical center. Anginal symptoms, optimal medical therapy, antianginal therapy, stress test results, and angiographic lesions (including American College of Cardiology/American Heart Association [ACC/AHA] lesion type) were analyzed. Logistic regression was used to determine predictors of medical management among patients not referred for coronary artery bypass surgery. ResultsOf the 207 patients with obstructive lesions amenable to PCI, 163 underwent PCI and 44 were referred to medical therapy. In the multivariable logistic model, the following variables were associated with medical management: advancing age (odds ratio [OR] per 1 year: 0.94, 95% confidence interval [CI]: 0.91-0.98), chronic kidney disease (OR: 0.23, 95% CI: 0.06-0.95), distal location (OR: 0.21, 95% CI: 0.09-0.48), and ACC/AHA type C lesion (OR: 0.08, 95% CI: 0.03-0.22). There was no association with sex, race, symptoms, optimal medical therapy, maximal antianginal therapy, referral status, or type of interventional cardiologist (academic vs private practice). ConclusionsFor patients undergoing cardiac catheterization for stable angina, the decision to proceed to PCI vs medical management appears to depend largely on patient and angiographic characteristics, but not on symptoms or ischemia. Distal and high-risk lesions (ACC/AHA type C) are more often referred for medical therapy.

引用

页码：207 / 214

页数：8

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