Real-world implementation of ESC guidelines in chronic coronary syndromes: Insights from the EURECA registry with a focus on Italian practice.
Abstract
INTRODUCTION The EURECA registry showed that 2019 ESC guideline adoption (GA) for management of Chronic Coronary Syndromes is suboptimal regarding the use of diagnostic tests. The present sub-analysis compared Italian cohort (IC) versus non-Italian cohorts (NIC) and explored Italian regional differences.
Methods
Patients were grouped into NIC and IC, this further stratified in Northern, Central, and Southern regions. GA was assessed for the choice of first diagnostic test (Endpoint-A) and for the overall diagnostic pathway (Endpoint-B). Quality-of-life, additional diagnostic test and MACE were assessed at 6-month.
Results
Among 4262 patients, 38.4% (1636) were enrolled in Italy (May-2019/March-2020). GA was suboptimal in both cohorts but higher in Italy (p < 0.001 for Endpoint-A and B). In IC vs. NIC exercise-ECG and coronary-CT-angiography were used more frequently (39.6% vs. 25.5%, 35.0% vs. 20.2%; p < 0.001) while stress-imaging and invasive coronary angiography (ICA) were less used (39.4% vs. 45.9%, 22.9% vs. 34.5%; p < 0.001 for both). Exercise-ECG and ICA remained the main drivers of non-GA in both cohorts. Final diagnosis of obstructive-CAD was less frequent in IC than NIC (19.9% vs. 26.9%; p < 0.001), with similar rate of ischemia detection (19. % vs. 18.9%; p = 0.74) and revascularization (12.8% vs. 14.0%; p = 0.27). GA, obstructive-CAD, ischemia, treatment changes and revascularizations were low in Italian-southern region. Six-month MACE was low and not associated with GA in both cohorts.
Conclusions
The rate of GA was higher in IC as compared with the NIC but still suboptimal, especially in Italian-southern region. Non-GA was mainly driven by exercise-ECG and ICA as first test use.