Current management and treatment of patients with stable coronary artery diseases presenting to cardiologists in different clinical contexts: A prospective, observational, nationwide study

Abstract

Background Stable coronary artery disease (CAD) is a leading cause of mortality worldwide. Few studies document the complete sequence of investigation of the overall stable CAD population during outpatient visits or hospitalisation. Aim To obtain accurate and up-to-date information on current management of patients with stable CAD. Methods START (STable coronary Artery diseases RegisTry) was a prospective, observational, nationwide study aimed at evaluating the presentation, management, treatment and quality of life of stable CAD patients presenting to cardiologists during outpatient visits or discharged from cardiology wards. Results Over a 3-month period, 5070 consecutive patients were enrolled in 183 participating centres: 72% managed by a cardiologist during outpatient or day hospital visits and 28% discharged from cardiology wards. The vast majority of patients (87%) received a coronary angiography (86% of patients managed during outpatient visits and 90% during hospitalisation; p < 0.0001). Outpatients more frequently received optimal medical therapy (OMT; i.e. aspirin or thienopyridine, β-blockers and statins) compared to hospitalised patients (70.2% vs 67.1%; p = 0.03). A personalised diet was prescribed in 58% (60.5% in outpatients and 52.9% in those admitted to hospitals; p < 0.0001), physical activity programmes were suggested in 65% (69.4% and 54.3%; p < 0.0001) and smoking cessation was recommended in 71% of currently smoking patients (73.2% and 65.2%; p = 0.02). Conclusions In this large, contemporary registry, patients with stable CAD discharged from cardiology wards more commonly underwent diagnostic imaging procedures and less frequently received OMT or lifestyle modification programmes compared to patients manged by cardiologists during outpatient visits.

Lipid Lowering Treatment and Eligibility for PCSK9 Inhibition in Post-Myocardial Infarction Patients in Italy: Insights from Two Contemporary Nationwide Registries

“…e methods used to set up each registry have been described previously [17,18]. Brie y, their primary objectives were to evaluate clinical characteristics as well as management and treatment of stable CAD patients admitted to Italian cardiology centres, using a catchment method broad enough to provide data representative of the entire country.…”

“…Using the data from the STable Coronary Artery Diseases RegisTry (START) [17] and the EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTaly) Post-MI [18], two Italian contemporary, nationwide registries on patients with stable coronary artery disease (CAD), we sought to describe the lipid lowering therapies prescribed in those with a prior MI and the resulting eligibility for PCSK9 inhibitors according to the criteria recommended by ESC/EAS and Italian regulatory agency.…”

Value of Cardiogoniometry in Diagnosis of Coronary Artery Disease in Patients with Suspected Stable Ischemic Heart Disease

“…[56][57][58][59] Therefore, one of the leading concerns in the management of ISHD patients is the attempt to find more criteria based on non-invasive diagnostic tools, like what we attempted to do, toward a better decision-making strategy for the possibility of coronary stenosis. [60][61][62][63] Comparison with other meta-analysis: This was the first meta-analysis on the diagnostic value of CGM in detect-ing CAD in people with suspected SIHD and who are candidates for elective angiography. Hence, its findings can be useful in determining the approach of physicians compared to this non-invasive modality.…”

Editor’s Presentation

“…In a nationwide, contemporary, prospective registry of 5070 consecutive, unselected, stable CAD patients enrolled over three months in 183 cardiology Italian centres, patients discharged from cardiology wards more commonly underwent diagnostic imaging procedures and less frequently received optimal medical therapy or lifestyle intervention programmes compared with patients managed by cardiologists during outpatient visits. 10…”