Lack of implementation of guidelines recommendations for coronary revascularization in stable patients with complex disease is associated with high rates of incomplete revascularization Analysis from the Apache study

被引：6

作者：

Marino, Marcello ^{[1
]}

Leonardi, Sergio ^{[2
]}

Crimi, Gabriele ^{[2
]}

Ferrario, Maurizio ^{[2
]}

Musumeci, Giuseppe ^{[3
]}

Tarantini, Giuseppe ^{[4
]}

Lettieri, Corrado ^{[5
]}

Bettari, Luca ^{[6
]}

Maddalena, Lettino ^{[7
]}

De Luca, Leonardo ^{[8
]}

Varbella, Ferdinando ^{[9
]}

De Servi, Stefano ^{[10
]}

机构：

[1] Osped Maggiore Crema, Cardiol Unit, Crema, Italy

[2] Univ Pavia, Fdn IRCCS Policlin San Matteo, Pavia, Italy

[3] Osped Santa Croce Carle, Div Cardiol, Cuneo, Italy

[4] Univ Hosp Padua, Div Cardiol, Padua, Italy

[5] Osped Carlo Poma, Div Cardiol, Mantua, Italy

[6] Poliambulanza Fdn Hosp Inst Brescia, Cardiovasc Dis, Brescia, Italy

[7] Clin Inst Humanitas IRCCS, Div Cardiol, Rozzano, Italy

[8] Giovanni Evangelista Hosp Tivoli, Div Cardiol, Rome, Italy

[9] Osped Infermi Hosp, Rivoli, Italy

[10] IRCCS Multimed, Milan, Italy

来源：

HEART AND VESSELS | 2020年 / 35卷 / 01期

关键词：

Revascularization appropriateness; Complete revascularization; Coronary disease; Percutaneous coronary intervention; Coronary artery bypass graft; APPROPRIATE USE CRITERIA; ARTERY-DISEASE; AD HOC; INTERVENTION; SURGERY; OUTCOMES; QUANTIFICATION; VALIDATION; PREDICTORS; MANAGEMENT;

D O I：

10.1007/s00380-019-01459-1

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The objective of this study is to evaluate completeness of coronary revascularization in patients with complex stable coronary artery disease (SCAD) who underwent percutaneous coronary interventions (PCI), but a surgical revascularization indicated according to 2018 European Society of Cardiology guidelines. The optimal mode of revascularization for SCAD should take into account clinical, anatomic, and procedural characteristics-including anticipated completeness of revascularization-and modality of treatment should be discussed by a Heart Team. Among patients enrolled in the APpropriAteness of percutaneous Coronary interventions in patients with ischemic heart disease study, we identified patients with complex SCAD. Rates of ad-hoc PCI and documented heart team discussion were reported stratified by guideline recommended mode of revascularization. Completeness of revascularization was assessed by an angiographic core laboratory using residual SS (rSS) <= 8 and SYNTAX Revascularization Index (SRI) >= 70%. Among 336 PCI patients with SCAD, 182 (54.2%) had complex coronary disease and 152 underwent ad-hoc PCI (83.5%). Patients for whom surgery was the recommended revascularization option (9.3%) had a significantly and substantial higher rate of incomplete revascularization than patients for whom either mode of revascularization or PCI was recommended (61.3% vs 23.6% with rSS > 8, p < 0.001 and 77.4% vs 44.6% with SRI < 70%, p < 0.001). Patients with complex SCAD receiving percutaneous myocardial revascularization when surgery was recommended have substantially incomplete myocardial revascularization. These data support multidisciplinary decision-making in these patients and suggest considering anticipated completeness when deciding mode of coronary revascularization.

引用

页码：30 / 37

页数：8

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