FCR-07
Comparison of the ISCHEMIA Trial Population to Patients Undergoing Percutaneous Coronary Intervention in US Practice: A Cathpci National Cardiovascular Data Registry (NCDR) Research to Practice (R2P) Initiative
Presenter
Saurav Chatterjee, M.D., FSCAI, Northshore and Long Island Jewish Hospitals of the Northwell Health System/ Assistant Professor, Zucker School of Medicine, New York, NY
Saurav Chatterjee, M.D., FSCAI1, Alexander Craig Fanaroff, MD, MHS2, Craig Parzynski, PhD3, Jeptha P. Curtis, M.D.4, Daniel M. Kolansky, M.D., FSCAI5, Debabrata Mukherjee, M.D., MSCAI6, Thomas Maddox, MD7, Robert W. Yeh, M.D., FSCAI8 and Jay S. Giri, MD, FSCAI5, (1)Northshore and Long Island Jewish Hospitals of the Northwell Health System/ Assistant Professor, Zucker School of Medicine, New York, NY, (2)Hospital of the University of Pennsylvania, Gladwyne, PA, (3)Senior Statistician, Yale Center for Cardiac Outcomes and Research Evaluation, New Haven, CT, (4)Yale University, New Haven, CT, (5)Hospital of the University of Pennsylvania, Philadelphia, PA, (6)Texas Tech University, El Paso, TX, (7)Department Of Veterans Affairs, St Louis, MO, (8)Beth Israel Deaconess Medical Center, Boston, MA
Keywords: Coronary and Quality
Background -The ISCHEMIA trial, which enrolled patients with stable ischemic heart disease (SIHD), showed that revascularization improved angina symptoms with no effect on death or myocardial infarction. The proportion of patients undergoing percutaneous coronary interventions (PCI) for SIHD in current interventional practice in the US that meets ISCHEMIA inclusion criteria is unknown.
Methods -Cross-sectional analysis of the National Cardiovascular Data Registry (NCDR) CathPCI Registry, between October 2017 and June 2019 including 1662 hospitals enrolling patients into the registry was done. Participants included patients undergoing PCI for SIHD in routine clinical practice. Those meeting ISCHEMIA trial inclusion criteria: 1) SIHD; 2) moderate to severe ischemia on functional testing; 3) lack of high risk anatomic or clinical features (i.e. left ventricular systolic dysfunction, end-stage renal disease, left main coronary artery disease)-and those not meeting the same, were identified.
Results -388,212 patients underwent PCI for SIHD in the defined timeframe, comprising 42.9% of all patients undergoing PCI during the study period. Of these, 125,302 (32.3%; 13.5% of all patients undergoing PCI) met criteria for enrollment in the ISCHEMIA trial. Among SIHD patients that did not meet criteria, 71,852 (18.5%) had SIHD with high-risk features (35.2% left main disease, 43.7% left ventricular systolic dysfunction, 16.8% end-stage renal disease), 67,159 (17.3%) had SIHD with negative or low-risk functional testing, and 123,899 (31.9%) either had no stress testing or did not have ischemic burden reported. At the median hospital, 32.1% (IQR, 23.5-40.6%) of SIHD patients met criteria for enrollment in the ISCHEMIA trial. Compared with the other SIHD cohorts, the ISCHEMIA-like cohort had the lowest in-hospital mortality rate (0.1%, p<0.01), and comparable in-hospital bleeding (0.6%), and acute kidney injury requiring hemodialysis (0.04%).
Conclusions -Among contemporary US patients undergoing PCI for SIHD, only 13.5% met enrollment criteria for the ISCHEMIA trial. There was significant variation among individual centers in the proportion of SIHD patients meeting criteria for the ISCHEMIA trial.