Discrepancy between the European clinical guidelines and myocardial revascularization in patients with stable coronary artery disease in Russia

In European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines, six indications have been proposed for making a decision on myocardial revascularization in patients with stable coronary artery disease (CAD). Our aim was to study a discrepancy between the actual clinical situation and ESC/EACTS indications on performing the revascularization in patients with CAD in Russia. We used retrospective clinical data on patients with stable CAD enrolled in the 20122015 Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure. A total of 1522 patients with CAD (aged 53.0 8.5 years, 76.2% male) were used for analysis. All patients were divided into two groups: 591 patients with performed myocardial revascularization (named as R-CAD) and 931 patients refused from revascularization (named as NR-CAD). Factors associated with revascularization performance were identified by discriminant function analysis. ESC/EACTS indications for revascularization were assessed. A total of 1196 patients with CAD had any ESC/EACTS indication for revascularization, but only 40.2% of them had performed invasive coronary intervention. Myocardial revascularization was appropriate in 81.4% of R-CAD patients and 76.8% of NR-CAD patients. The main factor of revascularization performance was any stenosis > 50% and grades IIIIV of stable angina. With non-performed revascularization, the following factors were associated: limiting angina or angina equivalent, unresponsive to medical therapy, atherosclerotic peripheral arterial disease and increasing the New York Heart Association class of chronic heart failure. Most ESC/EACTS indications had little effect on decision-making on revascularization. There is a discrepancy between the actual clinical situation and ESC/EACTS guidelines on myocardial revascularization in patients with stable CAD in Russia.