Abstract 18210: Impact of AHA/ACC Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention Guidelines on Real-world Treatment Strategies for Complex Coronary Artery Disease
Introduction: 2011 ACCF/AHA coronary artery bypass grafting (CABG) guideline and percutaneous coronary intervention (PCI) guideline were published on December 2011.The aim of this study is to explore the impact of guidelines’ publication on real-world treatment for three-vessel or left-main coronary artery disease (CAD).
Hypothesis: The release of revascularization guidelines has a positive impact on real-world practice and 1-year outcomes of patients with complex CAD.
Methods: Between July 2011 and September 2012, patients diagnosed as three-vessel or left-main CAD at Fuwai hospital were consecutively enrolled. We reviewed medical records to abstract detailed in-hospital information. The Corelab calculated SYNTAX Scores according to coronary angiograms. We conducted follow-up at 12 months after the index hospitalization. The end point was major adverse cerebral and cardic event (MACCE) including death, myocardial infarction, stroke and additional revascularization. Patients were then divided into pre-guideline group and post-guideline group according to the conary angiography date. Binary viariables logistic model and Cox model were uesd for baseline and 1-year outcomes comparison respectively
Results: 1746 patients were consecutively enrolled. 37.9% (662) were in pre-guideline group, 62.1% (1084) in post-guideline group. There were no significant differences in demographic factors, cardiac surgery risks and SYNTAX Scores between pre- and post-guideline groups. After the publication of 2011 ACCF/AHA guidelines, doctors recommended more patients to choose CABG (pre: 49.0%, post: 55.6%, p<0.05), the surgeons’ consultation rate increased (pre: 41.9%, post: 49.9%, p<0.05), the rate of ad hoc PCI (PCI immediately after coronary angiography) decreased (pre: 47.5%, post: 40.9%, p<0.05). After adjustment for coronary anatomy complexity and cardiac surgery risks using Cox model, pre-guideline group was associated with significantly higher rates of MACCE (HR=1.62, 95% confidential interval: 1.15-2.27).
Conclusions: The publication of 2011 ACCF/AHA CABG and PCI guidelines significantly changed real-world treatment for complex CAD in Fuwai hospital, and further improved outcomes.
- Coronary artery disease
- Coronary artery bypass grafting (CABG)
- Percutaneous coronary intervention (PCI)
Author Disclosures: C. Rao: None. S. Hu: None. Z. Zheng: None. X. Yuan: None. K. Hua: None. H. Zhang: None.
- © 2014 by American Heart Association, Inc.