Response to Letter Regarding Article, “Revascularization Decisions in Patients With Stable Angina and Intermediate Lesions: Results of the International Survey on Interventional Strategy”

Tóth, Gábor G.; Toth, Balint; Vroey, Frederic De; Serafino, Luigi Di; Pyxaras, Stylianos A.; Ruşinaru, Dan; Gioia, Giuseppe Di; Pellicano, Mariano; Barbato, Emanuele; Mieghem, Carlos Van; Heyndrickx, Guy R.; Bruyne, Bernard De; Wijns, William; Johnson, Nils P.

doi:10.1161/circinterventions.115.002296

Cited by 24 publications

(30 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, angiographic completeness of coronary revascularization might also carry a certain clinical importance, considering the limited adoption rates of invasive physiologic assessment globally. 37 Fourth, as the current study mainly focused on the comparison of clinical outcomes between angiographic CR and IR groups, the lack of an appropriate comparator, such as medical treatment or coronary artery bypass grafting, makes inferences incomplete. Fifth, the proportion of acute kidney injury after the index procedure could not be evaluated.…”

Section: Limitationsmentioning

confidence: 99%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThere are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug‐eluting stent era.Methods and ResultsBetween 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient‐oriented composite outcomes (POCO, a composite of all‐cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non‐CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62–0.95, P=0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%–1.85%, P=0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction.ConclusionsAngiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients.

show abstract

Section: Limitationsmentioning

confidence: 99%

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Kim

Lee

Choi

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…The lack of contemporary information about the quality of clinical interpretations of coronary angiograms may undermine the benefit of PCI, as the presence and severity of coronary stenosis play a key role in the selection of patients . Recent data revealed that physicians tended to assess coronary lesions treated with PCI as more severe than measurements by angiographic core lab . Importantly, with the rapid growth of PCI procedures in China, there is rising concern about the selection of patients and the appropriateness of PCI performance .…”

Section: Discussionmentioning

confidence: 99%

The china patient‐centered evaluative assessment of cardiac events (PEACE) prospective study of percutaneous coronary intervention: Study design

Dreyer

et al. 2016

Cathet Cardio Intervent

View full text Add to dashboard Cite

BackgroundThe number of percutaneous coronary interventions (PCI) in China has increased more than 20‐fold over the last decade. Consequently, there is a need for national‐level information to characterize PCI indications and long‐term patient outcomes, including health status, to understand and improve evolving practice patterns. Objectives: This nationwide prospective study of patients receiving PCI is to: (1) measure long‐term clinical outcomes (including death, acute myocardial infarction [AMI], and/or revascularization), patient‐reported outcomes (PROs), cardiovascular risk factor control and adherence to medications for secondary prevention; (2) determine patient‐ and hospital‐level factors associated with care process and outcomes; and (3) assess the appropriateness of PCI procedures. Methods: The China Patient‐centered Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of PCI has enrolled 5,000 consecutive patients during 2012–2014 from 34 diverse hospitals across China undergoing PCI for any indication. We abstracted details of patient's medical history, treatments, and in‐hospital outcomes from medical charts, and conducted baseline, 1‐, 6‐, and 12‐month interviews to characterize patient demographics, risk factors, clinical presentation, healthcare utilization, and health status using validated PRO measures. The primary outcome, a composite measure of death, AMI and/or revascularization, as well as PROs, medication adherence and cardiovascular risk factor control, was assessed throughout the 12‐month follow‐up. Blood and urine samples were collected at baseline and 12 months and stored for future analyses. To validate reports of coronary anatomy, 2,000 angiograms are randomly selected and read by two independent core laboratories. Hospital characteristics regarding their facilities, processes and organizational characteristics are assessed by site surveys. Conclusion: China PEACE Prospective Study of PCI will be the first study to generate novel, high‐quality, comprehensive national data on patients’ socio‐demographic, clinical, treatment, and metabolic/genetic factors, and importantly, their long‐term outcomes following PCI, including health status. This will build the foundation for PCI performance improvement efforts in China. © 2016 The Authors. Catheterization and Cardiovascular Interventions. Published by Wiley Periodicals, Inc.

show abstract

“…20 Second, several investigators have reported discrepancies between the severity of visual estimation of coronary angiographic stenosis and the severity of functional coronary stenosis. 3,4,22 Compared with quantitative coronary angiography, visual assessment by clinicians tends to overestimate lesion severity in patients undergoing PCI. 23 Visual assessment of the coronary lesion stenosis has a high degree of inter-and intraobserver variability, which may lead to inadequate lesion treatment and coverage or alternatively to overcoverage.…”

Section: Discussionmentioning

confidence: 99%

Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice?

et al. 2016

View full text Add to dashboard Cite

Overdiagnosis and overtreatment are often thought of as relatively recent phenomena in modern medicine, influenced by a contemporary combination of technology, specialization, payment models, marketing, and supply-related demand. Several investigators have reported discrepancies between the angiographic and functional severity of coronary angiographic stenosis. However, the visual anatomic assessment of the coronary lesion severity continues in daily practice. We evaluated the consecutive all coronary angiograms performed between January 2015 and December 2015 and examined only patients who had previous coronary artery bypass grafting (CABG) to analyze the cases with regard to presence of the competitive flow (CF) between the native left anterior descending coronary artery (LAD) and left internal mammary artery (LIMA) graft. A total of 8,248 diagnostic coronary angiographies were performed between January 2015 and December 2015 at our facility. Of these, 886 coronary angiographies of CABG patients were detected. Whereas LIMA graft occlusion detected in 19 patient (2.1%), the LIMA-LAD CF rate was found in 86 (9.7%) CABG patients. The angiographic severity of the LAD stenosis in CF group evaluated as mild in 20 (25%), moderate in 61 (70%), and severe coronary artery disease in 4 (5%) patients. Our results showed that there is 9.7% rate of LIMA-LAD CF. Therefore, some unnecessary coronary stenting or CABG procedures might have been performed due to limited use of functional testing for clinical decision making. The functional angiography should play a more prominent role in catheterization laboratories as recommended by current revascularization guidelines to prevent overdiagnosis, misdiagnosis, or incorrect treatment decisions.

show abstract

Response to Letter Regarding Article, “Revascularization Decisions in Patients With Stable Angina and Intermediate Lesions: Results of the International Survey on Interventional Strategy”

Cited by 24 publications

References 6 publications

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug‐Eluting Stent Era

The china patient‐centered evaluative assessment of cardiac events (PEACE) prospective study of percutaneous coronary intervention: Study design

Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice?

Contact Info

Product

Resources

About