Details

Autor(en) / Beteiligte

• Wein, Bastian
• Seleznova, Yana
• Mueller, Dirk
• Naumann, Marie
• Loeser, Simon
• Steffen, Melanie
• Windhoevel, Ute
• Haude, Michael
• vom Dahl, Juergen
• Schaefer, Ulrich
• Montenbruck, Moritz
• Jegodka, Ruediger
• Dill, Thorsten
• Guelker, Jan-Erik
• Boese, Dirk
• Bogs, Björn
• Harmel, Eva
• Bruder, Oliver

Titel

Guideline adherence in the use of coronary angiography in patients presenting at the emergency department without myocardial infarction – Results from the German ENLIGHT-KHK project

Ist Teil von

• International journal of cardiology. Heart & vasculature, 2023-12, Vol.49, p.101281-101281, Article 101281

Ort / Verlag

Elsevier B.V

Erscheinungsjahr

2023

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Figure Legend – Patients presenting at the emergency department in whom acute myocardial infarction is not the issue undergoing coronary angiography for suspected obstructive coronary artery disease with presenting symptoms, presence of intermediate risk criteria* (diabetes mellitus, renal insufficiency (eGFR <60 ml/min/1.73m2), early post-infarction angina (defined as <3 months after AMI), prior coronary revascularization, or a GRACE Score between 110 and 139) or prior non-invasive, image-guided testing** (with either stress-echocardiography, coronary CT-angiography, myocardial perfusion scintigraphy or stress cardiac magnetic resonance imaging). Evaluation of the guideline adherence in the use of a coronary angiography according to the 2015 and 2020 European Society of Cardiology guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation*** (ESC ACS GL), respectively. [Display omitted] •Guideline-adherent use of coronary angiography in 64% with the 2015 but only 20% with the 2020 ESC-ACS guideline recommendations.•Fundamental shift in recommendations from invasive to non-invasive testing between the 2015 and 2020 ESC-ACS guidelines.•Efforts to overcome structural barriers to expand the use of non-invasive image guided testing are crucial. For patients with acute myocardial infarction (AMI), direct coronary angiography (CA) is recommended, while for non-AMI patients, the diagnostic work-up depends on clinical criteria. This analysis provides initial prospective German data for the degree of guideline-adherence (GL) in the use of CA on non-AMI patients presenting at the emergency department (ED) with suspected acute coronary syndrome (ACS) according to the 2015 ESC-ACS-GL. Furthermore the implications of the application of the 2020 ESC-ACS-GL recommendations were evaluated. Patient symptoms were identified using a standardized questionnaire; medical history and diagnostic work-up were acquired from health records. In accordance with the 2015 ESC-ACS-GL, CA was considered GL-adherent if intermediate risk criteria (IRC) were present or non-invasive, image-guided testing (NIGT) was pathological. Between January 2019 and August 2021, 229 patients were recruited across seven centers. Patients presented with chest pain, dyspnea, and other symptoms in 66.7%, 16.2% and 17.1%, respectively, were in mean 66.3 ± 10.5 years old, and 36.3% were female. In accordance with the 2015 ESC-ACS-GL, the use of CA was GL-adherent for 64.0% of the patients. GL-adherent compared to non-adherent use of CA resulted in revascularization more often (44.5% vs. 17.1%, p < 0.001). Applying the 2020 ESC-ACS-GL, 20.4% of CA would remain GL-adherent. In the majority of cases, the use of CA was adherent to the 2015 ESC-ACS-GL. With regard to the 2020 and 2023 ESC-ACS-GL, efforts to expand the utilization of NIGT are crucial, especially as GL-adherent use of CA is more likely to result in revascularization. (German Clinical Trials Register DRKS00015638; https://drks.de/search/de/trial/DRKS00015638; (registration date: 19 February 2019))