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

Prospective evaluation of guideline-adherence of coronary angiography in patients without acute myocardial infarction presenting at the emergency department – Results from the ENLIGHT-KHK trial.

B. Wein1, J. vom Dahl2, M. Haude3, C. M. Montenbruck4, U. Schäfer4, R. Jegodka5, M. Zarse6, D. Böse7, J. Gülker8, T. Dill9, M. Steffen10, O. Bruder10, 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; 5Kardiologie, Elisabeth-Krankenhaus GmbH, Recklinghausen; 6Märkische Kliniken GmbH, Lüdenscheid; 7Klinik für Kardiologie, Klinikum Hochsauerland GmbH, Arnsberg; 8Innere Medizin IV - Kardiologie und Rhythmologie, Petrus-Krankenhaus, Wuppertal; 9Innere Medizin und Kardiologie, Sana Krankenhaus Benrath, Düsseldorf; 10Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen GmbH, Essen;

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. 1/3 of CA is considered to be performed in patients with acute coronary syndromes (ACS). ST-elevation and non-ST-elevation myocardial infarctions (NSTEMI) are clear indications for direct CA. In troponin-negative patients though, the indication for CA according to the European Society of Cardiology guidelines on ACS without persistent ST-elevation (ESC ACS) should only be set in certain clinical circumstances. ENLIGHT-KHK is the first prospective observational trial to evaluate guideline adherence of CA in patients presenting at the emergency department with suspected myocardial ischemia and excluded acute myocardial infarction undergoing CA for suspected obstructive coronary artery disease in Germany. 1.2 Methods Guideline-adherence was evaluated according to the current ESC ACS guidelines 2020 and 2015. Patient symptoms were identified using a standardized questionnaire and were grouped into typical, atypical angina, non-anginal chest pain or dyspnea. Previous history, the presence of risk criteria and the pre-CA diagnostic work-up were taken from health records and the patient questionnaire. CA was considered guideline-adherent if certain criteria defining an intermediate risk (e.g. prior PCI, chronic kidney disease or diabetes) were met. If these were not met, CA was only considered guideline-adherent if the indication was set according to the ESC guidelines on chronic coronary syndrome (CCS) 2019, as suggested in the ESC ACS guidelines. 1.3 Results 229 patients presenting at the emergency department and having troponin-values in the normal range, were recruited by 9 different centres in North Rhine-Westphalia and Hamburg between January 2019 and August 2021. Patients were in mean 66,2 years old, male in 62,5%, had known CCS in 44,5% and presented with typical, atypical or non-anginal chest pain in 28,8%, 41,1% and 29,3%, respectively. 16,2% had concomitant dyspnea. According to the ESC ACS guidelines 63,8% met the intermediate risk criteria and were considered guideline-adherent. From the remaining 82 patients 2 were considered guideline-adherent. Altogether, CA in this population was guideline-adherent according to the respective ESC guidelines in 64,6%. 1.4 Conclusion This is the first German prospective observational multicentre trial to evaluate guideline adherence of CA in a population of troponin-negative patients presenting at the emergency department. In nearly 2/3 of patients CA were guideline-adherent, primarily due to the presentation of certain risk criteria defining an intermediate risk for an ischemic cause of symptoms. In the latter 1/3 of patients, non-invasive image guided testing (NIGT) would have been the guideline recommended approach. This underuse of NIGT could be targeted in the health care system.

https://dgk.org/kongress_programme/jt2022/aP2040.html