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ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 14
Original paper

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Jakub Chmiel, Miłosz K. Książek, Weronika Stryszak, Paweł Iwaszczuk, Mateusz K. Hołda, Grażyna Świtacz, Artur Kozanecki, Piotr Wilkołek, Paweł Rubiś, Grzegorz Kopeć, Piotr Odrowąż-Pieniążek, Tadeusz Przewłocki, Wiesława Tracz, Piotr Podolec, Piotr Musiałek

Adv Interv Cardiol 2018; 14, 3 (53): 247–257
Online publish date: 2018/09/21
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Invasive coronary angiography (CAG), the ‘gold standard’ in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources.

To assess recent (throught out 10 years) evolution of ‘significant’ (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center.

Material and methods
Anonymized medical records were compared from the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001).

The median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories.

Despite more advanced age and a higher proportion of subjects with ‘any’ coronary atherosclerosis on CAG, the likelihood of a ‘negative’ angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.


diagnosis, angiography, coronary artery disease, coronary angiography, invasive evaluation, coronary angiogram

Cierniak-Piotrowska M. Marciniak G, Stańczak J. Coronary artery disease death and mortality statistics. In: Cardiovascular Morbidity and Mortality in the Context of Demographic Status in Poland. Strzelecki Z, Szymborski J (eds). Rządowa Rada Ludnościowa, Warsaw, Poland 2015 [in Polish]. Available at: https://bip.stat.gov.pl/files/gfx/bip/pl/zamowieniapubliczne/426/248/1/81_gp_rrl_2015_monografia_kardiologiczna.pdf. Accessed July 20, 2018.
Podolec P, Jankowski P, Zdrojewski T, et al. Polish Forum for prevention guidelines on cardiovascular risk assessment: update 2016. Kardiol Pol 2017; 75: 84-6.
Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2018 August 25 (Epub ahead of print).
Wang XL, Tam C, McCredie RM, Wilcken DE. Determinants of severity of coronary artery disease in Australian men and women. Circulation 1994; 89: 1974-81.
Enbergs A, Bürger R, Reinecke H, et al. Prevalence of coronary artery disease in a general population without suspicion of coronary artery disease: angiographic analysis of subjects aged 40 to 70 years referred for catheter ablation therapy. Eur Heart J 2000; 21: 45-52.
Giannoglou GD, Antoniadis AP, Chatzizisis YS, et al. Sex-related differences in the angiographic results of 14,500 cases referred for suspected coronary artery disease. Coron Artery Dis 2008; 19: 9-14.
Mancini GBJ, Hartigan PM, Shaw LJ, et al. Predicting outcome in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation): coronary anatomy versus ischemia. JACC Cardiovasc Interv 2014; 7: 195-201.
Iwaszczuk P, Kołodziejczyk B, Kruczek T, et al. Ischemic versus non-ischemic (neurogenic) myocardial contractility impairment in acute coronary syndromes: prevalence and impact on left ventricular systolic function recovery. Med Sci Monit 2018; 24: 3693-701.
National Health Fund [Poland] – 2016 Statistics: Category E27 – Coronary angiography and other invasive procedures in ICD9 (88.55; 88.56; 88.57). Available at: https://prog.nfz.gov.pl/app-jgp/Grupa.aspx?id=_0W1X74ndRo%3D. Accessed: July 20, 2018.
Kolkailah AA, Alreshq RS, Muhammed AM, et al. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev 2018; 4: CD012318.
Kostkiewicz M, Konieczynska M, Szot WM, et al. Comparison between (99m)Tc-MIBI myocardial perfusion SPECT and multi-slice computed tomography for identifying and assessing coronary artery disease. Hell J Nucl Med 2004; 7: 48-51.
Mowatt G, Cummins E, Waugh N, et al. Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technol Assess 2008; 12: 1-143.
Płońska-Gościniak E, Kasprzak JD, Olędzki S, et al. Polish Stress Echocardiography Registry (Pol-STRESS registry) – a multicentre study. Stress echocardiography in Poland: numbers, settings, results, and complications. Kardiol Pol 2017; 75: 922-30.
Rubiś P, Drabik L, Kopeć G, et al. The prognostic role of exercise echocardiography in heart failure. Kardiol Pol 2011; 69: 656-63.
Lala A, Desai AS. The role of coronary artery disease in heart failure. Heart Fail Clin 2014; 10: 353-65.
Ko BS, Wong DT, Cameron JD, et al. 320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study. Eur Radiol 2014; 24: 738-47.
Gurunathan S, Senior R. Stress echocardiography in stable coronary artery disease. Curr Cardiol Rep 2017; 19: 121.
Musiałek P. TASTE-less endpoint of 30-day mortality (and some other issues with TASTE) in evaluating the effectiveness of thrombus aspiration in STEMI: not the “evidence” to change the current practice of routine consideration of manual thrombus extraction. Kardiol Pol 2014; 72: 479-87.
Musialek P, Mazurek A, Trystula M, et al. Novel PARADIGM in carotid revascularisation: Prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard™ MicroNet-covered embolic prevention stent system. EuroIntervention 2016; 12: e658-70.
Tomkiewicz-Pajak L, Wojcik T, Chłopicki S, et al. Aspirin resistance in adult patients after Fontan surgery. Int J Cardiol 2015; 181: 19-26.
Musialek P, Tekieli L, Kostkiewicz M, et al. Randomized transcoronary delivery of CD34(+) cells with perfusion versus stop-flow method in patients with recent myocardial infarction: early cardiac retention of 99(m)Tc-labeled cells activity. J Nucl Cardiol 2011; 18: 104-16.
Musialek P, Tekieli L, Kostkiewicz M, et al. Infarct size determines myocardial uptake of CD34+ cells in the peri-infarct zone: results from a study of (99m)Tc-extametazime-labeled cell visualization integrated with cardiac magnetic resonance infarct imaging. Circ Cardiovasc Imaging 2013; 6: 320-8.
Musialek P, Mazurek A, Jarocha D, et al. Myocardial regeneration strategy using Wharton’s jelly mesenchymal stem cells as an off-the-shelf ‘unlimited’ therapeutic agent: results from the Acute Myocardial Infarction First-in-Man Study. Postep Kardiol Inter 2015; 11: 100-7.
Bartunek J, Terzic A, Davison BA, et al. Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial. Eur Heart J 2017; 38: 648-60.
Majka M, Sułkowski M, Badyra B, et al. Mesenchymal stem cells in cardiovascular regeneration: emerging research directions and clinical applications. Stem Cells Transl Med 2017; 6: 1859-67.
Chiha J, Mitchell P, Gopinath B, et al. Gender differences in the severity and extent of coronary artery disease. Int J Cardiol Heart Vasc 2015; 8: 161-6.
Dean J, Dela Cruz S, Mehta PK, et al. Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy. Nat Rev Cardiol 2015; 12: 406-14.
Knuuti J, Ballo H, Juarez-Orozco LE, et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J 2018 May 29. [Epub ahead of print].
Hamilton-Craig C, Strugnell WE, Raffel OC, et al. CT angiography with cardiac MRI: non-invasive functional and anatomical assessment for the etiology in newly diagnosed heart failure. Int J Cardiovasc Imaging 2012; 28: 1111-22.
Medical Advisory Secretariat – Ministry of Health and Long-Term Care [Ontario, Canada]. 64-slice computed tomographic angiography for the diagnosis of intermediate risk coronary artery disease: an evidence-based analysis. Health Quality Ontario. Ont Health Technol Assess Ser 2010; 10: 1-44.
Yamanaka F, Shishido K, Ochiai T, et al. Diagnostic performance of 320-slice computed tomography coronary angiography for symptomatic patients in clinical practice. Eur J Intern Med 2017; 39: 57-62.
Olszowska M, Musiałek P, Drwiła R, et al. Progressive bradycardia with increasing doses of dobutamine leading to stress echo interruption. Cardiol J 2012; 19: 79-80.
Sara JD, Widmer RJ, Matsuzawa Y, et al. Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease. JACC Cardiovasc Interv 2015; 8: 1445-53.
Szot W, Zajac J, Kubinyi A, Kostkiewicz M. The effects of cardiac rehabilitation on overall physical capacity and myocardial perfusion in women with microvascular angina. Kardiol Pol 2016; 74: 431-8.
Shaw LJ, Merz CN, Pepine CJ, et al. The economic burden of angina in women with suspected ischemic heart disease: results from the National Institutes of Health – National Heart, Lung, and Blood Institute – sponsored Women’s ischemia syndrome evaluation. Circulation 2006; 114: 894-904.
Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010; 362: 886-95.
Doukky R, Shih MJ, Rahaby M, et al. A simple validated clinical tool to predict the absence of coronary artery disease in patients with systolic heart failure of unclear etiology. Am J Cardiol 2013; 112: 1165-70.
Gierlotka M, Gąsior M, Wilczek K, et al. Temporal trends in the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction in Poland from 2004-2010 (from the Polish Registry of Acute Coronary Syndromes). Am J Cardiol 2012; 109: 779-86.
Zandecki L, Sadowski M, Janion M, et al. Trends in sex differences in clinical characteristics, treatment strategies, and mortality in patients with ST-elevation myocardial infarction in Poland from 2005 to 2011. Coron Artery Dis 2017; 28: 417-25.
Gąsior M, Pres D, Wojakowski W, et al. Causes of hospitalization and prognosis in patients with cardiovascular diseases. Secular trends in the years 2006-2014 according to the SILesian CARDiovascular (SILCARD) database. Pol Arch Med Wewn 2016; 126: 754-62.
Loaldi A, Annoni L, Apostolo A, et al. Coronary angiographic features in 2,234 patients with clinical suspicion of coronary heart disease without modifiable risk factors. Jpn Heart J 1993; 34: 11-21.
Lansky AJ, Ng VG, Maehara A, et al. Gender and the extent of coronary atherosclerosis, plaque composition, and clinical outcomes in acute coronary syndromes. JACC Cardiovasc Imaging. 2012; 5 (3 Suppl.): S62-72.
Bradley SM, Maddox TM, Stanislawski MA, et al. Normal coronary rates for elective angiography in the Veterans Affairs Healthcare System: insights from the VA CART program (veterans affairs clinical assessment reporting and tracking). J Am Coll Cardiol 2014; 63: 417-26.
Waldo SW, Gokhale M, O’Donnell CI, et al. Temporal trends in coronary angiography and percutaneous coronary intervention: insights from the VA Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv 2018; 11: 879-88.
Yeh RW, Mauri L, Wolf ER, et al. Population trends in rates of coronary revascularization. JAMA Intern Med 2015; 175: 454-6.
Kosecoff J, Kahn KL, Rogers WH, et al. Prospective payment system and impairment at discharge. The ‘quicker-and-sicker’ story revisited. JAMA 1990; 264: 1980-3.
Palmer KS, Agoritsas T, Martin D, et al. Activity-based funding of hospitals and its impact on mortality, readmission, discharge destination, severity of illness, and volume of care: a systematic review and meta-analysis. PLoS One 2014; 9: e109975.
Wu VY, Shen YC. Long-term impact of Medicare payment reductions on patient outcomes. Health Serv Res 2014; 49: 1596-615.
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