1. APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study
- Author
-
Maddalena Lettino, Marianna Adamo, Giuseppe Tarantini, Andrea Pavei, Marta Brancati, Florinda Maiorana, Gabriele Crimi, Diego Rizzotti, Marco Zuccari, Giampaolo Pasquetto, Luca Bettari, Ferdinando Varbella, Stefano De Servi, Simone Tresoldi, Carlo Sponzilli, Leonardo De Luca, Luigi Pedon, Daniela Trabattoni, Marcello Marino, Giuseppe Tarelli, Mario Bollati, Paolo Sganzerla, Paola Camisasca, Arnaldo Poli, Giuseppe Musumeci, Corrado Lettieri, Panciroli C, Sergio Ghiringhelli, Luciano Bassan, and Sergio Leonardi
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Percutaneous ,medicine.medical_treatment ,Pilot Projects ,Coronary Artery Disease ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Coronary artery disease ,03 medical and health sciences ,coronary heart disease ,multidisciplinary decision making ,percutaneous coronary intervention ,Medicine (all) ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,business.industry ,Research ,Patient Selection ,Percutaneous coronary intervention ,General Medicine ,Guideline ,Middle Aged ,medicine.disease ,Cardiac surgery ,Surgery ,Pre- and post-test probability ,Treatment Outcome ,Italy ,Practice Guidelines as Topic ,Conventional PCI ,Female ,Guideline Adherence ,business - Abstract
ObjectivesTo first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation.DesignRetrospective, pilot study.Setting22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery.Participants440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics.Primary and secondary outcome measuresProportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD.ResultsOf the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001).ConclusionsUse of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement.Trial registration numberNCT02748603.
- Published
- 2017
- Full Text
- View/download PDF