Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China
Open Access
- 12 December 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Chinese Medical Journal
- Vol. 133 (1), 1-8
- https://doi.org/10.1097/cm9.0000000000000592
Abstract
Background: The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients. Methods : We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission. Results: From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45–0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52–1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51–1.23; P = 0.308). Conclusions: In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making. Clinical trial registration: NCT02880605. https://www.clinicaltrials.gov .Keywords
This publication has 24 references indexed in Scilit:
- Clinical Relevance of Coronary Fractional Flow ReserveChinese Medical Journal, 2015
- Validation of the Appropriate Use Criteria for Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease (from the COURAGE Trial)The American Journal of Cardiology, 2015
- Appropriateness of coronary interventions in Japan by the US and Japanese standardsAmerican Heart Journal, 2014
- Assessing the Association of Appropriateness of Coronary Revascularization and Clinical Outcomes for Patients With Stable Coronary Artery DiseaseJournal of the American College of Cardiology, 2012
- Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary DiseaseThe New England Journal of Medicine, 2012
- ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused updateThe Journal of Thoracic and Cardiovascular Surgery, 2012
- ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed TomographyJournal of the American College of Cardiology, 2012
- Percutaneous Coronary Intervention Plus Medical Therapy Reduces the Incidence of Acute Coronary Syndrome More Effectively Than Initial Medical Therapy Only Among Patients With Low-Risk Coronary Artery Disease: A Randomized, Comparative, Multicenter StudyJACC: Cardiovascular Interventions, 2008
- Optimal Medical Therapy with or without PCI for Stable Coronary DiseaseThe New England Journal of Medicine, 2007
- ACCF Proposed Method for Evaluating the Appropriateness of Cardiovascular ImagingJournal of the American College of Cardiology, 2005