Appropriateness of Treatment for Complex Coronary Artery Disease in Mainland China
Dachuan Gu, Chenfei Rao, Zhe Zheng.
Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
OBJECTIVE: The purpose of this study was to assess the appropriateness of treatment in a large multi-center prospective cohort of patients with 3-vessel disease (3VD) and left main disease (LM) in China. METHODS: Patients diagnosed of 3VD/LM by elective coronary angiography in 24 large cardiac surgical centers from 2012 to 2014 in China were consecutively recruited in this study. Patient characteristics were abstracted and SYNTAX score were calculated by well-trained researchers. Appropriateness assessing criteria was established based on 2014 European Society of Cardiology and European Association of Cardio-Thoracic Surgery Guidelines on myocardial revascularization, and was used to determine the appropriateness of treatment fro 3VD/LM. The treatment was defined as appropriate if it met the Class I and Class IIa recommendations, and as inappropriate if it met the Class IIb and Class III recommendations. RESULTS: A total of 2422 patients were enrolled in this study and treated by CABG, PCI, or medical therapy, with an overall appropriate rate of 57.3%. CABG was appropriate for all the patients. However, 2143 (88.5%) patients were treated by PCI or medical therapy, instead of CABG, with an inappropriate rate of 50.2%. Medical therapies were 100% inappropriate (n=422), while 35.6% of the 1721 PCI procedures were inappropriate. We identified certain variations in appropriateness among sites (23%-74.5%), wards (50%-78%) and cardiologists (48%-82%). Procedure-related risk factors (SinoSCORE, chronic kidney disease, age) and complexity of coronary lesions (SYNTAX Score, LM) were independent risk factors for inappropriate treatment. There was no statistically significant correlation between treatment volumes of site, ward, or cardiologist and the appropriateness of treatment (Pearson correlation index: site: 0.278, p=0.222; ward: 0.455, p>0.05; cardiologist: 0.216, p>0.05). CONCLUSIONS: The appropriateness of treatment for 3VD/LM was generally low in China, with significant variations among sites, wards and cardiologists. Great opportunity exists to improve the appropriateness of treatment.
|All patients (n=2422)||Appropriate(n=1388)||Inappropriate (n=1034)|
|Medical therapy, n(%)||422||0(0)||422(100)|
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