Reasons of Non-Guideline-Concordant Treatment in Patients with Multivessel Coronary Artery Disease Regret -One Trial

Objective: We aimed to find the prevalence and the reasons for receiving non-guideline-concordant treatment in patients with multivessel coronary artery disease (mv-CAD), at a single centre.

Methods: All consecutive patients who underwent coronary angiography, due to stable angina pectoris or non-ST-elevation acute coronary syndrome (NSTE-ACS), and were diagnosed with mv-CAD at our hospital between August 2017 and February 2018 were included in this study. Stand-alone medical treatment, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or hybrid revascularization is recommended treatment methods by The European Society of Cardiology (ESC) and The European Association for Cardio-Thoracic Surgery Guidelines (EACTS) on Myocardial Revascularisation. Stabilised NSTE-ACS patients were assessed as stable angina pectoris patient

Results: A total of 140 patients (96 male, 68.6% and 111 NSTE-ACS, 79.3%) were included in this study, of which 65 (46.4%) received non-guideline-concordant treatment and 75 patients (53.6%) received guideline-concordant treatment. Sociodemographic and clinical characteristics did not differ statistically between patients who received guideline-concordant treatment and non-guideline-concordant treatment. Patients that received non-guideline-concordant treatment did so for the following reasons: patient’s preference and/or cardiologist’s decision of PCI over CABG (42, 64.6%), patient’s refusal of the revascularization method (14, 21.5 %), refusal by the surgery team to perform surgery due to advanced patient age or low left ventricular ejection fraction (5, 7.7%),unavailability of the surgery team (1, 1.5%) and developing ischaemia/myocardial infarction during the waiting period (3, 4.6 %). There was no inappropriate CABG decision.

Conclusions: In our study, the prevalence of non-guideline-concordant treatment was high and associated primarily with the preferences of the interventional cardiologists and patients.