Guideline adherence in the use of coronary angiography in patients presenting at the emergency department without myocardial infarction - Results from the German ENLIGHT-KHK project

Bastian Wein; Yana Seleznova; Dirk Mueller; Marie Naumann; Simon Loeser; Melanie Steffen; Ute Windhoevel; Michael Haude; Juergen Vom Dahl; Ulrich Schaefer; Moritz Montenbruck; Ruediger Jegodka; Thorsten Dill; Jan-Erik Guelker; Dirk Boese; Björn Bogs; Eva Harmel; Oliver Bruder

doi:10.1016/j.ijcha.2023.101281

Guideline adherence in the use of coronary angiography in patients presenting at the emergency department without myocardial infarction - Results from the German ENLIGHT-KHK project

Int J Cardiol Heart Vasc. 2023 Oct 20:49:101281. doi: 10.1016/j.ijcha.2023.101281. eCollection 2023 Dec.

Authors

Bastian Wein^{1

2}, Yana Seleznova³, Dirk Mueller³, Marie Naumann³, Simon Loeser⁴, Melanie Steffen¹, Ute Windhoevel⁵, Michael Haude⁶, Juergen Vom Dahl⁷, Ulrich Schaefer⁸, Moritz Montenbruck⁹, Ruediger Jegodka¹⁰, Thorsten Dill¹¹, Jan-Erik Guelker^{12

13}, Dirk Boese¹⁴, Björn Bogs¹, Eva Harmel², Oliver Bruder^{1

15}

Affiliations

¹ Elisabeth-Hospital, Contilia Heart and Vascular Centre, Essen, Germany.
² Cardiology, Faculty of Medicine, University of Augsburg, Germany.
³ Institute for Health Economics and Clinical Epidemiology, University of Cologne, Germany.
⁴ AOK Rheinland-Hamburg, Dusseldorf, Germany.
⁵ CERC Deutschland GmbH, Essen, Germany.
⁶ Rheinlandklinikum Neuss, Germany.
⁷ Mariahilf Hospital, Moenchengladbach, Germany.
⁸ Heart and Vascular Centre, Bad Bevensen, Germany.
⁹ Marien-Hospital, Hamburg, Germany.
¹⁰ Elisabeth Hospital, Recklinghausen, Germany.
¹¹ Sana Hospital Benrath, Medical Department, Dusseldorf, Germany.
¹² Petrus Hospital, Department of Cardiology and Rhythmology, Wuppertal, Germany.
¹³ University Witten/Herdecke, Faculty of Health, Witten, Germany.
¹⁴ Hochsauerland Hospital, Department of Cardiology, Arnsberg, Germany.
¹⁵ Ruhr University Bochum, Germany.

Abstract

Background: For patients with acute myocardial infarction (AMI), direct coronary angiography (CA) is recommended, while for non-AMI patients, the diagnostic work-up depends on clinical criteria. This analysis provides initial prospective German data for the degree of guideline-adherence (GL) in the use of CA on non-AMI patients presenting at the emergency department (ED) with suspected acute coronary syndrome (ACS) according to the 2015 ESC-ACS-GL. Furthermore the implications of the application of the 2020 ESC-ACS-GL recommendations were evaluated.

Methods: Patient symptoms were identified using a standardized questionnaire; medical history and diagnostic work-up were acquired from health records. In accordance with the 2015 ESC-ACS-GL, CA was considered GL-adherent if intermediate risk criteria (IRC) were present or non-invasive, image-guided testing (NIGT) was pathological.

Results: Between January 2019 and August 2021, 229 patients were recruited across seven centers. Patients presented with chest pain, dyspnea, and other symptoms in 66.7%, 16.2% and 17.1%, respectively, were in mean 66.3 ± 10.5 years old, and 36.3% were female. In accordance with the 2015 ESC-ACS-GL, the use of CA was GL-adherent for 64.0% of the patients. GL-adherent compared to non-adherent use of CA resulted in revascularization more often (44.5% vs. 17.1%, p < 0.001). Applying the 2020 ESC-ACS-GL, 20.4% of CA would remain GL-adherent.

Conclusions: In the majority of cases, the use of CA was adherent to the 2015 ESC-ACS-GL. With regard to the 2020 and 2023 ESC-ACS-GL, efforts to expand the utilization of NIGT are crucial, especially as GL-adherent use of CA is more likely to result in revascularization.(German Clinical Trials Register DRKS00015638; https://drks.de/search/de/trial/DRKS00015638; (registration date: 19 February 2019)).

Keywords: Chest pain; Coronary angiography; Emergency department; Guideline; Guideline adherence.