Article
Guidelines Adherence in Treatment of Patients Suffering from Chronic Coronary Artery Disease and Diabetes Mellitus – a REVASK Database Analysis
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Authors
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Marion Ludwig
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Germany
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Annika Vivirito
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Germany
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Jutta Küpper-Nybelen
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, PMV forschungsgruppe, Köln, Germany
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Andreas Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
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Eva Maria Bitzer
- Pädagogische Hochschule Freiburg, Freiburg, Germany
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Dirk Horenkamp-Sonntag
- Techniker Krankenkasse, Hamburg, Germany
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Ursula Marschall
- BARMER Berlin, Berlin, Germany
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Steffen Schneider
- Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung, Düssedorf, Germany; Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Jochen Walker
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Germany
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Ulrich Zeymer
- Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung, Düssedorf, Germany; Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Peter Ihle
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, PMV forschungsgruppe, Köln, Germany
| Published: | September 6, 2024 |
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Outline
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Background: The German National Care Guideline on chronic coronary artery disease (cCAD) (NVL -cKHK) and the European Guidelines on myocardial revascularization recommend coronary artery bypass grafting (CABG) as the preferred revascularization procedure for patients with multivessel cCAD and diabetes mellitus (DM). As complex cCAD is often associated with DM these vulnerable patients have increased morbidity from cardiovascular events and higher mortality rates. This study contributes to the evaluation of guideline adherence and aims to highlight factors favoring CABG vs. percutaneous coronary intervention (PCI) in patients with cCAD and DM.
Methods: As a part of the REVASK-study this retrospective, observational analysis utilized pseudonymized routine data from German statutory health insurance for the years 2016-2020, provided by the scientific institute InGef and the two health insurance companies BARMER and Techniker Krankenkasse. All patients with cCAD receiving an incident myocardial revascularization in 2018 were included. Patients were divided into two groups according to the type and setting of revascularization and the presence or absence of DM. Further comorbidities and diagnostic coronary angiography 365 days prior to revascularization were identified based on ICD-10 GM and OPS codes, respectively. A stepwise logistic regression model was used to identify factors favoring CABG over PCI in the CAD+DM subcohort.
Results: In total, 29,777 patients were included (17,508 with cCAD; 12,269 with cCAD+DM). 4.969 patients underwent isolated CABG, 2,895 (16.5%) CAD patients and 2,074 (16.9%) CAD+DM patients, respectively. Compared to cCAD patients, a larger part of CAD+DM patients were affected by relevant documented comorbidities such as renal insufficiency, arteriosclerosis, obesity, or congestive heart failure. Moreover, the proportion of relevant comorbidities was significantly different between CABG and PCI for both subcohorts. The main predictor of receiving CABG instead of PCI was severity of CAD as patients with three vessel disease and left main stenosis had a 20-fold increased chance for a CABG procedure compared to patients with two vessel disease.
Discussion: cCAD patients with and without DM showed no difference in the use of CABG, which questions the implementation of guidelines recommendations in daily practice. The main predictor for receiving CABG is the cCAD severity. In addition, the majority of patients with incident PCI receive one-time procedure (cardiac catheterization and PCI) that might impede patient-centered decision-making. Further investigations with detailed clinical data (morphology) are needed.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
