Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Prospective evaluation of guideline-adherence in patients transferred for coronary angiography for suspected obstructive stable coronary artery disease – Results from the ENLIGHT-KHK trial
B. Wein1, J. vom Dahl2, M. Haude3, C. M. Montenbruck4, T. Dill5, R. Jegodka6, J. Gülker7, D. Böse8, M. Zarse9, U. Schaefer10, M. Steffen11, W. Windhövel12, Y. Seleznova13, O. Bruder11, für die Studiengruppe: ENLIGHT-KHK
1I. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg; 2Klinik für Kardiologie und Int. Intensivmedizin, Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach; 3Medizinische Klinik I, Rheinland Klinikum Lukaskrankenhaus, Neuss; 4Zentrum Innere Medizin, Katholisches Marienkrankenhaus gGmbH, Hamburg; 5Innere Medizin und Kardiologie, Sana Krankenhaus Benrath, Düsseldorf; 6Kardiologie, Elisabeth-Krankenhaus GmbH, Recklinghausen; 7Innere Medizin IV - Kardiologie und Rhythmologie, Petrus-Krankenhaus, Wuppertal; 8Klinik für Kardiologie, Klinikum Hochsauerland GmbH, Arnsberg; 9Märkische Kliniken GmbH, Lüdenscheid; 10Katholisches Marienkrankenhaus gGmbH, Hamburg; 11Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen GmbH, Essen; 12CERC Deutschland GmbH, Essen; 13Insitut für Gesundheitsökonomie und Epidemiologie der Universtitätsklinik Köln, Köln;
1.1 Background and Aims With 900’000 coronary angiographies (CA) per year, Germany has the highest annual per capita volume in Europe, 1.7 times higher than 2nd placed Austria. 2/3 of these are done in patients without acute myocardial infarction. Albeit indirect hints and a longstandig discussion, ENLIGHT-KHK is the first prospective observational trial to evaluate guideline adeherence of CA in patients with suspected obstructive stable coronary artery disease (SCAD) in Germany.

1.2 Methods Guideline-adherence was evaluated according to the current German National Disease Management Guideline (GNDMG) on stable coronary artery disease (SCAD) and the European Society of Cardiology guidelines on Chronic Coronary Syndrome (ESC CCS). Patient symptoms were identified using a standardized questionnaire and were grouped into typical, atypical angina, non-anginal chest pain or dyspnea. Pretest-probability (PTP) as the central step was determined using age, sex, and the patients’ symptoms. The pre-CA diagnostic process, especially non-invasive image guided ischemia testing was taken from health records and the questionnaire.

1.3 Results 458 patients were recruited by 9 different centres in North Rhine-Westphalia and Hamburg between January 2019 and August 2021. Patients were in mean 66,5 years old, male in 57,6%, had known SCAD in 47,4% and presented with typical, atypical or non-anginal chest pain in 33,8%, 39,5%, and 22,5%, respectively. 25,3% had solely or concomitant dyspnea. PTP according to the GMG was in mean 47,8%, according to the ESC CCS 19,1%. 21,2% had preceding non-invasive image guided testing (NIGT) with either Stress-Echocardiography, Stress-MRI, Myocardial Perfusion Scintigraphy or CT-Coronary Angiography. Exercise-ECG was performed in 15,7% prior to CA. Direct CA was performed in 63,1%. Altogether, using the GNDMG on SCAD 74,9% of CA in this population were not guideline-adherent, according to the ESC CCS guidelines 77,3%.

1.4 Conclusion This is the first prospective observational multicentre trial to clearly demonstrate the guideline-non-adherence of CA in patients with suspected obstructive SCAD in Germany. The underuse of NIGT needs to be targeted in the health care system.

https://dgk.org/kongress_programme/jt2022/aP2039.html