SPC365

How are interventional cardiologists making their treatment decisions during invasive coronary angiography?

Session: Posters (Sessão 2 - Écran 3) - Doença arterial coronária
Speaker: Maria Teresa Barros

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.8 Coronary Artery Disease - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Maria Teresa Barros; Miguel Santos; Pedro Magno; José Loureiro; Luis Brizida; Pedro Farto e Abreu; Carlos Morais; Sérgio Bravo Baptista

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.5pt">Introduction: </span></strong><span style="font-size:11.5pt">Indications for revascularization in coronary artery disease (CAD) have clearly identified criteria and although there are several studies looking at the adequacy of these decisions per patient or per procedure, there is no information on the way operators are doing their treatment decisions at a lesion level.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.5pt">Population and Methods: </span></strong><span style="font-size:11.5pt">All consecutive patients (pts) who underwent coronary angiography in a single year were evaluated and all significant (&gt;50% lesions) were recorded. The study&rsquo;s primary endpoint was the criteria for revascularization used in each lesion and the adequacy of this treatment decision according to the guideline-based indications (including culprit lesions in ACS, lesions with proved ischemia by invasive or non-invasive imaging tests, lesions &gt;90% and single lesions with a positive ischemia test). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.5pt">Results</span></strong><span style="font-size:11.5pt">: Of an initial group of 1525 significant lesions (in 544 pts), in 166 lesions the decision was to undergo further non-invasive testing (which means no treatment decision was made at the time of the procedure). Additionally, 345 lesions were in pts referred for surgical revascularization. The remaining 1014 lesions were included in the analysis. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="font-size:11.5pt">The proportion of treatment decisions made according to the current evidence-based guidelines (primary endpoint) was 47.2%, as compared to 24.5% treatment decisions only based on the operator&rsquo;s opinion. The remaining 28.3% (287 lesions) treatment decisions&nbsp;were influenced by other anatomical, clinical or other circumstantial factors (including CTO&rsquo;s, small vessels, very distal lesions and/or coronary bypass in the same territory). When this last group was excluded from the analysis, the percentage of non-guideline-based treatment decisions in the remaining 727 lesions was 34.1%. In this last group, when only non-culprit lesions were accounted (n=425), this percentage went up to 58.1%. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="font-size:11.5pt">Importantly, if we only consider the lesions for which there was no clear guideline-based indication for revascularization (n=298), a treatment decision was immediately made without further evidence (that is, without using the available tools for invasive ischemia assessment &ndash; FFR or iFR) in 83.2% of the cases. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="font-size:11.5pt">Non-guideline-based treatment decisions were associated with older pts (median 71 vs. 68 y, p=0.01) and longer procedures (median 60 vs. 54 min, p=0.005). </span></span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:11.5pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11.5pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">At a lesion-level, around one quarter of the treatment decisions in CAD pts was made without evidence-based information, but this number was significantly higher when only non-culprit lesions or lesions suitable for invasive ischemia evaluation were considered. </span></span></p>