Saratov JOURNAL of Medical and Scientific Research

Drug treatment of stable coronary artery disease in the context of guidelines on myocardium revascularization

Year: 2019, volume 15 Issue: №3 Pages: 812-817
Heading: Cardiology Article type: Original article
Authors: Posnenkova О.М., Genkal E.N., Popova Yu.V., Kiselev A.R., Gridnev V.I.
Organization: Saratov State Medical University

Purpose: to assess the quality of medical treatment in patients with stable coronary artery disease (CAD) based on 2018 European guidelines on coronary revascularization (ESC 2018) and 2017 Appropriate Use Criteria (AUC 2017) using the data from Russian multicenter registry. Material and Methods. The data from 1531 patients with stable CAD (mean age 61.7±9.8 yrs, 76% men) were studied. The source of data was Russian multicenter registry of hypertension, CAD and chronic heart failure. Administration of optimal medical therapy (OMT) in terms of ESC 2018, maximal antiischemic therapy (MAT) in terms of AUC 2017 and agreement with both criteria were evaluated. OMT included at least one antiischemic drug + antiplatelet agent + statin + short acting nitrate + RAAS blocker in patients with hypertension, diabetes and heart failure. MAT included at least two antiischemic grugs. Correspondence with these criteria was determined in the groups of patients who underwent coronary revascularization and who received only medical treatment. The criteria were also determined in the groups of patients, for whom invasive treatment were indicated primarily, for whom it could be delayed and among patients who did not need revascularization according to ESC 2018 and AUC 2017 Results. In patients treated conservatively (n=924) OMT was administered in 18% of cases, in the group of revascularization — in 9% of cases (p<0.001). MAT was also administered significantly more frequently in the group of medical treatment (34% vs 24% in the group of revascularization, p=0.001). Medical treatment met ESC 2018 and AUC 2017 criteria in the groups with and without intervention in 7 and 3% of cases correspondingly (p<0.001). Conclusion. The data of Russian multicenter registry have shown that medical treatment of stable CAD fit with European and American clinical guidelines on myocardium revascularization in only insignificant part of patients independently from selected treatment strategy.

1 Kiselev AR, Korotin AS, Posnenkova OM, et al. Discrepancy between the European clinical guidelines and myocardial revascularization in patients with stable coronary artery disease in Russia. International Journal for Quality in Health Care 2019; 31 (4): 269-75. DOI: 10.1093/intqhc/mzy140.
2 Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease/The Task force on the management of stable coronary artery disease of the European Society of Cardiology. European Heart Journal 2013; 34 (38): 2949-3003. DOI: 10.1093/eurheartj/eht296.
3 Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine 2007; 356(15): 1503-16. DOI: 10.1056/NEJMoa070829.
4 Korotin AS, Popova YuV, Genkal EN, et al. Evaluation of myocardial revascularization in stable coronary heart disease patients and factors associated with invasive strategy choice. Cardiovascular Therapy and Prevention 2017; 16 (4): 18-24. DOI: 10.15829/1728-8800-2017-4-18-24.
5 Windecker SI, Falk V, Jun P, et al. 2014 ESC/EACT Guidelines on myocardial revascularization/The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio Thoracic Surgery (EACT). European Heart Journal 2014; 35: 2541-619.
6 Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eurolntervention2019; 14(14): 1435-534.
7 Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal 2019; 00: 1-71. DOI: 10.1093/eurheartj/ehz425.
8 Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AAT S/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients with Stable Ischemic Heart Disease. J Nucl Cardiol 2017; 24: 1759 DOI: 10.1007/sl 2350-017-0917-9.
9 Al-Lamee R, Thompson D, Dehbi HM, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 2018; 391 (10115): 31-40. DOI: 10.1016/S0140-6736 (17) 32714-9.
10 Gridnev VI, Kiselev AR, Posnenkova OM, et al. Objectives and design of Russian Registry of Hypertension, Coronary Artery Disease, and Chronic Heart Failure. Russian Open Medical Journal 2017; 6: e0201.
11 Posnenkova OM, Genkal EN, Popova YuV, et al. Application of information technologies for selection of treatment strategy in patients with stable coronary artery disease. Cardio-IT 2019; 6 (1): e0201.
12 Campeau L. Grading of angina pectoris. Circulation 1976; 54(3): 522-3.
13 BordenWB, Redberg RF, MushlinAI.etal. Patternsand intensity of medical therapy in patients undergoing percutaneous coronary intervention. JAMA 2011; 305 (18): 1882-9. DOI: 10.1001 /jama. 2011.601.
14 Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; 356 (15): 1503-16.
15 Xaplanteris P, Fournier S, Pijls NHJ, et al. Five-Year Outcomes with PCI Guided by Fractional Flow Reserve: FAME 2 Investigators. N Engl J Med 2018; 379 (3): 250-9. DOI: 10.1056/NEJMoa1803538.

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