Evaluation of the guideline-adherence of coronary angiography in patients with suspected chronic coronary syndrome – Results from the German prospective multicentre ENLIGHT-KHK project

• Published in: International journal of cardiology. Heart & vasculature 2023-06, Vol.46, p.101203-101203, Article 101203
• Main Authors: Wein, Bastian, Seleznova, Yana, Mueller, Dirk, Naumann, Marie, Loeser, Simon, Artmann, Joerg, Fritz, Thomas, Steffen, Melanie, Windhoevel, Ute, Haude, Michael, vom Dahl, Juergen, Schaefer, Ulrich, Montenbruck, Moritz, Zarse, Markus, Jegodka, Ruediger, Dill, Thorsten, Guelker, Jan-Erik, Boese, Dirk, Bruder, Oliver
• Format: Article
• Language: English
• Subjects: Angina pectoris; Chronic coronary syndrome; Coronary angiography; Coronary artery disease; Guideline adherence; Original Paper
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2023.101203

Figure Legend – Patients with suspected obstructive stable coronary artery disease undergoing coronary angiography included in the trial with presenting symptoms, mean pre-test probability (PTP) (according to the 2019 European Society of Cardiology guidelines on chronic coronary syndrome) and prior non-invasive image guided testing (NIGT) and the respective proportion of guideline-adherent and non-adherent coronary angiographies in this population. *PTP – pre-test probability; **NIGT – non-invasive image guided testing; *** according to the 2019 European Society of Cardiology guidelines on chronic coronary syndrome. [Display omitted] •Initial prospective German cohort to evaluate guideline-adherence of coronary angiography in suspected chronic coronary syndrome.•Guideline-adherence rate of coronary angiography in chronic coronary syndrome is 20.4 %.•Utilization of non-invasive image guided testing needs to be strengthened. With 900′000 coronary angiographies (CA) per year, Germany has the highest annual per capita volume in Europe. Until now there are no prospective clinical data on the degree of guideline-adherence in the use of CA in patients with suspected chronic coronary syndrome (CCS) in Germany. Between January 2019 and August 2021, 458 patients with suspected CCS were recruited in nine German centres. Guideline-adherence was evaluated according to the current European Society of Cardiology and German guidelines. Pre-test probability (PTP) for CAD was determined using age, gender, and a standardized patient questionnaire to identify symptoms. Data on the diagnostic work-up were obtained from health records. Patients were in mean 66.6 years old, male in 57.3 %, had known CAD in 48.4 % and presented with typical, atypical, non-anginal chest pain or dyspnoea in 35.7 %, 41.3 %, 23.0 % and 25.4 %, respectively. PTP according to the European guidelines was in mean 24.2 % (11.9 %-36.5 % 95 % CI). 20.9 % of the patients received guideline-recommended preceding non-invasive image guided testing. The use of CA was adherent to the European and German guideline recommendations in 20.4 % and 25.4 %, respectively. In multivariate-analysis, arterial hypertension and prior revascularization were predictors of guideline non-adherence. These are the first prospective clinical data which demonstrated an overall low degree of guideline-adherence in the use of CA in patients with suspected CCS in the German health care setting. To improve adherence rates, the availabili