European Heart Journal Advance Access originally published online on March 31, 2005
European Heart Journal 2005 26(12):1169-1179; doi:10.1093/eurheartj/ehi238
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Management and outcome of patients with established coronary artery disease: the Euro Heart Survey on coronary revascularization
1Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands
2Division of Cardiology, Lille University Heart Institute, Lille, France
3Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
4Cardiology Service, Hospital Central de Asturias, Asturias, Spain
5Division of Cardiology, Federico II University, Naples, Italy
6Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
7Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
8University Hospital Vinohrady, Prague, Czech Republic
9Cardiovascular Centre, OLV Hospital, 164 Moorselbaan, B 9300 Aalst, Belgium
Received 6 December 2004; revised 10 February 2005; accepted 23 February 2005; online publish-ahead-of-print 31 March 2005.
* Corresponding author. Tel: +32 53724439; fax: +32 53724185.E-mail address: william.wijns{at}olvz-aalst.be
See page 1147 for the editorial comment on this article (doi:10.1093/eurheartj/ehi247)
Aims The purpose of the Euro Heart Survey Programme of the European Society of Cardiology is to evaluate to which extent clinical practice endorses existing guidelines as well as to identify differences in population profiles, patient management, and outcome across Europe. The current survey focuses on the invasive diagnosis and treatment of patients with established coronary artery disease (CAD).
Methods and results Between November 2001 and March 2002, 7769 consecutive patients undergoing invasive evaluation at 130 hospitals (31 countries) were screened for the presence of one or more coronary stenosis >50% in diameter. Patient demographics and comorbidity, clinical presentation, invasive parameters, treatment options, and procedural techniques were prospectively entered in an electronic database (550 variables+29 per diseased coronary segment). Major adverse cardiac events (MACE) were evaluated at 30 days and 1 year. Out of 5619 patients with angiographically proven coronary stenosis (72% of screened population), 53% presented with stable angina while ST elevation myocardial infarction (STEMI) was the indication for coronary angiography in 16% and non-ST segment elevation myocardial infarction or unstable angina in 30%. Only medical therapy was continued in 21%, whereas mechanical revascularization was performed in the remainder [percutaneous coronary intervention (PCI) in 58% and coronary artery bypass grafting (CABG) in 21%]. Patients referred for PCI were younger, were more active, had a lower risk profile, and had less comorbid conditions. CABG was performed mostly in patients with left main lesions (21%), two- (25%), or three-vessel disease (67%) with 4.1 diseased segments, on average. Single-vessel PCI was performed in 82% of patients with either single- (45%), two- (33%), or three-vessel disease (21%). Stents were used in 75% of attempted lesions, with a large variation between sites. Direct PCI for STEMI was performed in 410 cases, representing 7% of the entire workload in the participating catheterization laboratories. Time delay was within 90 min in 76% of direct PCI cases. In keeping with the recommendations of practice guidelines, the survey identified under-use of adjunctive medication (GP IIb/IIIa receptor blockers, statins, and angiotensin-converting enzyme-inhibitors). Mortality rates at 30 days and 1 year were low in all subgroups. MACE primarily consisted of repeat PCI (12%).
Conclusion The current Euro Heart Survey on coronary revascularization was performed in the era of bare metal stenting and provides a global European picture of the invasive approach to patients with CAD. These data will serve as a benchmark for the future evaluation of the impact of drug-eluting stents on the practice of interventional cardiology and bypass surgery.
Key Words: Coronary artery disease • Coronary angiography • CABG • PCI • Practice survey
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