Management and outcome of patients with established coronary artery disease: The Euro Heart Survey on coronary revascularization

M. J. Lenzen, E. Boersma, M. E. Bertrand, W. Maier, C. Moris, F. Piscione, U. Sechtem, E. Stahle, P. Widimsky, P. De Jaegere, W. J M Scholte Op Reimer, N. Mercado, W. Wijns, B. Meier, P. Sergeant, J. Vos, F. Unger, Malika Manini, Claire Bramley, Valérie LaforestCharles Taylor, Susan Del Gaiso, Kurt Huber, Guy De Backer, Vera Sirakova, Roman Cerbak, Per Thayssen, Seppo Lehto, Jean Jacques Blanc, François Delahaye, Bondo Kobulia, Uwe Zeymer, Dennis Cokkinos, Kristof Karlocai, Ian Graham, Emer Shelley, Shlomo Behar, Aldo Maggioni, Virginija Grabauskiene, Jaap Deckers, Inger Asmussen, Janina Stepinska, Lino Gonçalves, Vyacheslav Mareev, Igor Riecansky, Miran F. Kenda, Angeles Alonso, José Luis Lopez-Sendon, Annika Rosengren, Peter Buser, Tugrul Okay, Oleg Sychov, Kevin Fox, David Wood, Eric Boersma, Harry Crijns, Kim Fox, Keith McGregor, Barbara Mulder, Sylvia Priori, Lars Rydén, Luigi Tavazzi, Alec Vahanian, Panos Vardas, William Wijns, Karine Sarkisyan, H. D. Glogar, Michael Derntl, Matthias Frick, O. Pachinger, Ralf Zwick, Christiaan Vrints, Els Van Hertbruggen, Marc Vercammen, Tineke Sysmans, E. Schroeder, Juliette Domange, Hilde De Pril, Johan De Vriese, Tonny Van Hecke, V. Legrand, Marie France Gillon, Michel Richardy, P. Doneux, Ivo Petrov, J. Jorgova, Boris Starcevic, Eric Eeckhout, Alexandre Berger, Veronique Prudent, E. Camenzind, Nicolas Masson, Costas Zambartas, Helen Kleanthous, Petr Widimsky, Blanka Stellova, Michael Aschermann, Stanislav Simek, J. Kautzner, Vladimir Karmazin, P. Svab, Jan Indrak, M. Branny, Kveta Hladilova, P. Kala, P. Thayssen, Helle Cappelen, Lisette Okkels Jensen, A. Gitt, Konstanze Gehrke, R. Erbel, Achim Gutersohn, Holger Eggebrecht, Murad Al Khani, Udo Sechtem, Antje Rosenberger, Holger Vogelsberg, H. Klepzig, Arnold Schmidt, Sigmund Silber, Birgit Mau, Christian Leuner, Karen Czyborra, Christina Reuschling, Eva Muno, F. Kleber, Sascha Rux, U. Zeymer, Aly Saad, B. S S Ibrahim, Maged Elabady, A. Castro Beiras, Jorge Salgado Fernandez, Felipe Navarro Del Arno, A. Iniguez Romo, J. M. Cruz Fernandez, Alejandro Recio Mayoreal, Franciso Javier Rivero Rebanal, Mariano Garcia De La Borbolla, Marinela Chaparro, C. Brotons, C. Permanyer Miralda, Srta Irma Vilai Perez, Cesar Moris, F. Fernandez Aviles, Luis De La Fuente Galan, Paula Tejedor Vinuela, F. Malpartida De Torres, Javier Mora, Ignacio Santos Rodriguez, Itziar Piedra Bustamante, Pedro L. Sanchez Fernandez, J. L. Diago Torrent, Jose L. Diez Gil, Javier Perpinan, V. Palacios Motilla, M. Soledad Alcasena Juango, Jesus Berjon-Reyero, R. Melgares Moreno, Juan Carlos Fernandez Guerrero, S. Lehto, Kirsti Savolainen, M. S. Nieminen, Mikko Syvanne, A. Cohen-Solal, Antoine Sylvain Oboa, J. P. Bassand, Denis Pales Espinosa, Veronique Jouet, G. Montalescot, Vanessa Gallois, J. C. Daubert, Jean Michel Clerc, Jacques Machecourt, Y. Cottin, D. Walker, Fhiona Holland, D. Wood, Jenni Prosser, Lis Muir, Kate Barber, J. G F Cleland, Jocelyn Cook, Zaza Chapichadze, Ioannis Skoularigisn Athanasiou Christos, Nastasia Tsiavou, Christina Chrysohoou, Athanassios Manginas, John Terrovitis, John Kanakakis, Manolis Vavuranakis, Stavros Drakos, Thomas Farmakis, C. Samara, Christina Papakosta, Christos Bourantas, L. K. Michalis, Mpourantas Christos, Stefanos Foussas, Evdokia Adamopoulou, P. E. Vardas, Mary Marketou, N. Alotti, Anna Maria Basa, Andras Vigh, Istvan Preda, Eva Csoti, M. Keltai, G. Kerkovits, Alberto Hendler, Alex Blatt, R. Beyar, Arie Shefer, David Halon, Margalait Bentzvi, Naomi Avramovitch, Avinoam Bakst, Carlos Cafri, Aviva Grosbard, Bella Margolis, Khalid Suleiman, Shmuel Banai, David Meerkin, Morris Mosseri, Pnina Guita, Rifat Jabara, Jamal Jafari, Debi Ben Shitrit, Ghasan, Salameh, Marc Brezins, Lily Van Den Akker-Berman, Victor Guetta, Yoseph Rozenman, A. Biagini, Sergio Berti, Massimo Ferrero, A. Colombo, R. Roccaforte, Caterina Milici, L. Scarpino, A. Salvi, Alessandro Desideri, Daniela Sabbadin, Alfredo Galassi, Giuseppe Giuffrida, Andrea Rognoni, Corrado Vassanelli, Paola Paffoni, Angelo Cioppa, Paolo Rubino, Marco De Carlo, Anna Sonia Petronio, F. Naccarella, Francesco Saia, Antonio Marzocchi, Stefano Sdringola Maranga, P. Presbitero, Fazya Valsecchi, Federico Piscione, Giovanni Esposito, Napoli M. Santini, Marco Tubaro, A. Erglis, Inga Narbute, Ausra Kavoliuniene, R. Zaliunas, Ramunas Navickas, V. Grabauskiene, Davia Luckute, Eduardas Subkovas, Daniel Wagner, F. Vermeer, Aimee Lousberg, Heidi Fransen, Arno Breeman, Henriette Tebbe, M. J. De Boer, Metske Van Der Wal, J. Deckers, Jeroen Vos, C. M. Leenders, M. J. Veerhoek, Chris Jansen, M. Bijl, Colinda Koppelaar, Den Linden Van Den Linden, R. Brons, J. W M G Widdershofen, Herman Broers, F. Kontny, Marianne Jonzon, Jan Wodniecki, Andrzej Tomasik, M. Trusz-Gluza, Seweryn Nowak, Witold Ruzyllo, Tomasz Deptuch, Jorge Marques, F. Matias, H. Madeira, Joaquim Oliveira, Luis Sargento, Adina Ionac, Iosif Stefan Dragulescu, Bogdan Mut-Vitcu, Daniela Maximov, M. Dorobantu, E. Apetrei, Rodica Niculescu, Virgil Petrescu, Adrian Bucsa, Dan Deleanu, I. S. Benedek, Theodora Hintea, D. Aronov, Elena Tikhomirova, I. Kranjec, Katja Prokselj, Vojko Kanic, Ahmet Sepetoglu, S. Aytekin, V. Aytekin, Alp Burak Catakoglu, Hayri Parlar, Suavi Tufekcioglu, Zeki Ozyedek, Mehmet Baltali, Kiziltan, Milan Vukovic, A. N. Neskovic

Research output: Contribution to journalReview articlepeer-review

Abstract

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 3/4 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.

Original languageEnglish (US)
Pages (from-to)1169-1179
Number of pages11
JournalEuropean Heart Journal
Volume26
Issue number12
DOIs
StatePublished - 2005
Externally publishedYes

Keywords

  • CABG
  • Coronary angiography
  • Coronary artery disease
  • PCI
  • Practice survey

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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