[논문]APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study

Leonardi, Sergio; Marino, Marcello; Crimi, Gabriele; Maiorana, Florinda; Rizzotti, Diego; Lettieri, Corrado; Bettari, Luca; Zuccari, Marco; Sganzerla, Paolo; Tresoldi, Simone; Adamo, Marianna; Ghiringhelli, Sergio; Sponzilli, Carlo; Pasquetto, Giampaolo; Pavei, Andrea; Pedon, Luigi; Bassan, Luciano; Bollati, Mario; Camisasca, Paola; Trabattoni, Daniela; Brancati, Marta; Poli, Arnaldo; Panciroli, Claudio; Lettino, Maddalena; Tarelli, Giuseppe; Tarantini, Giuseppe; De Luca, Leonardo; Varbella, Ferdinando; Musumeci, Giuseppe; De Servi, Stefano

doi:10.1136/bmjopen-2017-016909

APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study 원문보기

BMJ open, v.7 no.9, 2017년, pp.e016909 -

Leonardi, Sergio (Coronary Care Unit , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy) , Marino, Marcello (Cardiology , Ospedale Maggiore di Crema , Crema , Italy) , Crimi, Gabriele (Coronary Care Unit , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy) , Maiorana, Florinda (Coronary Care Unit , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy) , Rizzotti, Diego (Coronary Care Unit , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy) , Lettieri, Corrado (Cardiology , ASST Mantova–) , Bettari, Luca (Ospedale Carlo Poma , Mantova , Italy) , Zuccari, Marco (Cardiology , ASST Cremona–) , Sganzerla, Paolo (Ospedale di Cremona , Cremona , Italy) , Tresoldi, Simone (Cardiology , Ospedale Fornaroli di Magenta , Magenta , Italy) , Adamo, Marianna (Cardiology , ASST Bergamo Ovest–) , Ghiringhelli, Sergio (Ospedale di Treviglio , Treviglio , Italy) , Sponzilli, Carlo (Cardiology , Azienda Ospedaliera di Desio e Vimercate , Vimercate , Italy) , Pasquetto, Giampaolo , Pavei, Andrea , Pedon, Luigi , Bassan, Luciano , Bollati, Mario , Camisasca, Paola , Trabattoni, Daniela , Brancati, Marta , Poli, Arnaldo , Panciroli, Claudio , Lettino, Maddalena , Tarelli, Giuseppe , Tarantini, Giuseppe , De Luca, Leonardo , Varbella, Ferdinando , Musumeci, Giuseppe , De Servi, Stefano

Abstract ▼ AI-Helper

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.

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참고문헌 (22)

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APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study 원문보기

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