TCT-663 A United Kingdom Perspective on the Appropriateness of Percutaneous Coronary Intervention in Stable Angina

Abstract

Methods:We examined all patients In the NHLBI Dynamic Registry presenting with ACAD and SA to understand difference in clinical characteristics and 1-year adverse events. Results: Of all patients in the NHLBI Dynamic Registry, 2174 underwent PCI for SA, and 742 for ACAD. Patients receiving revascularization for ACAD compared to SA were more likely to have a history of congestive heart failure (14% vs 9%, pϽ0.0001) and HTN (75% vs 71%, pϽ0.05). In addition, Patients with ACAD had an increased prevalence of non-cardiac comorbidites compared to SA patients (43% vs 31%, pϽ0.0001) which included a significant increase in renal disease (10% vs 6% pϽ0.001), peripheral vascular disease (10% vs 7%, pϽ0.05), pulmonary disease (10% vs 6%, pϽ0.01), and cancer (15% vs 11%, p Ͻ0.01). The prevalence of hyperlipidemia (72% vs 75%) and diabetes (33% vs 30%) were similar in both groups. There were no differences between the extent of coronary artery disease or prior myocardial infarction in patient revascularized for ACAD and SA. The combined adjusted 1-year mortality and reinfaction incidence (hazard ratio 0.95; 95% CI; 0.69-1.3) were similar between ACAD and SA patients. Conclusions: Our analysis shows that patients with ACAD have similar 1-year outcomes to SA patients after undergoing PCI while having increased co-morbid conditions. Given these findings, further study is needed on the outcomes of patients with ACAD so that they can be more appropriately represented in the AUC guidelines. Background:The utilization of the 'appropriate use criteria' (AUC) has been controversial and suggested inappropriate and uncertain PCIs may not be uncommon. The issues raised are unlikely to be confined to the US. We therefore applied the AUC to patients with stable angina undergoing PCI at our tertiary centre in order to gain a UK perspective. Methods: We performed a restospective analysis of 200 consecutive patients with known stable angina referred from the chest pain clinic for PCI. The appropriateness of PCI was adjudicated using the published AUC and patients were grouped into those apparently undergoing appropriate, inappropriate or uncertain PCI.We determined the proportion of patients in the uncertain group who had either significant symptoms, intermediate risk or optimal medical therapy (OMT) in order to determine those in whom PCI is known to be beneficial and those where the evidence is less clear. Results: One hundred and twenty nine (64.5%) of PCIs were classified as appropriate, while 64 (32%) could be classified as uncertain indications and 7 (3.5%) were deemed inappropriate (Table 1). Inappropriate procedures were more common in patients with CCS I/II, those with low risk stress testing and in those not receiving OMT. Of the uncertain PCIs, 55 (85.9%) patients had either CCS III/IV, intermediate risk stress tests or were on OMT, with 9 (14.1%) having either CCS I/II, low risk stress tests or no OMT.

Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis

“…The America 2012 AUC were used in 11 studies [ 18 , 22 , 24 , 28 , 30 , 31 , 32 , 33 , 41 , 43 , 46 ], the America 2009 AUC were used in nine studies [ 25 , 26 , 27 , 29 , 36 , 40 , 48 , 51 , 52 ], the America 2017 AUC were used in three studies [ 21 , 34 , 50 ], and the China 2016 AUC and Japan 2007 AUC were both used once [ 37 , 53 ]. Thirteen studies were performed in the US [ 18 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 40 , 46 , 48 , 50 , 51 ], three in Japan [ 33 , 34 , 37 ], two in India [ 41 , 43 ], two in Canada [ 36 , 52 ], one in China [ 53 ], one in Pakistan [ 22 ], one in Indonesia [ 21 ], one in the UK [ 29 ], and one in both Canada and the US [ 24 ]. Five studies were performed in developing countries [ 21 ...…”