Application of information technologies for selection of treatment strategy in patients with stable coronary artery disease

Abstract

Purpose: to study the frequency of divergence occurrence between decisions which have been made on the basis of 2018 ESC guidelines on myocardial revascularization (ESC 2018) and 2012 Appropriate use criteria for coronary revascularization (AUC 2012) and develop the algorithm for support of clinical decision making on the need for revascularization and the appropriateness of performed intervention in patients with stable coronary artery disease (CAD). Material and Methods — The data of 1531 patients with stable CAD (mean age 61,7±9,8 yrs, 78% men) derived from multicenter Russian registry of patients with stable CAD were studied. Indications for myocardial revascularization were determined according ESC 2018 and AUC 2012. The following clinical characteristics were considered: severity of angina, the degree of coronary arteries stenoses, the data of non-invasive testing, volume of medication. Results — In 34% of patients treatment strategy according to ESC 2018 and AUC 2012 was similar. In 15% of patients ESC 2018 and AUC 2012 differed concerning revascularization appropriateness. In 50% of patients AUC 2012 have not been defined, predominantly due to insufficient examination. The algorithm was developed which allows on the basis of co-using of ESC 2018 and AUC 2012 compose groups of patients for whom myocardial revascularization indicated primarily (ЕSC 2018+, AUC 2012+), in whom intervention can be delayed (ЕSC ISSN 2313-0318, Cardio-IT DOI: 10.15275/cardioit.2019.0201 2/4 2019. Volume 6 Issue 2 Article CID e0201 Coronary Artery Disease © 2019, Cardio-IT www.cardio-it.ru 2018 +, AUC 2012 -/±/?) and for whom only drug treatment indicated (ЕSC 2018 -, AUC 2012 -/±/?). Developed algorithm was realized as an automated module of data analytics system of CAD registry. Its implementation in the studied group revealed that only 20% who underwent myocardial revascularization were referred to the group of primary revascularization. Among 334 patients for whom intervention was indicated on the primarily basis just 37% underwent it. Conclusion — Implementation of the developed algorithm as an automated analytical registry module allows processing of unlimited volume of clinical data and defining priority of myocardial revascularization performance. Patients with the maximal benefit from intervention should be operated on the primarily basis.