Evaluation of the guideline-adherence of coronary angiography in patients with suspected chronic coronary syndrome – Results from the German prospective multicentre ENLIGHT-KHK project

Abstract

With 900'000 coronary angiographies (CA) per year, Germany has the highest annual per capita volume in Europe. Until now there are no prospective clinical data on the degree of guideline-adherence in the use of CA in patients with suspected chronic coronary syndrome (CCS) in Germany. Between January 2019 and August 2021, 458 patients with suspected CCS were recruited in nine German centres. Guideline-adherence was evaluated according to the current European Society of Cardiology and German guidelines. Pre-test probability (PTP) for CAD was determined using age, gender, and a standardized patient questionnaire to identify symptoms. Data on the diagnostic work-up were obtained from health records. Patients were in mean 66.6years old, male in 57.3%, had known CAD in 48.4% and presented with typical, atypical, non-anginal chest pain or dyspnoea in 35.7%, 41.3%, 23.0% and 25.4%, respectively. PTP according to the European guidelines was in mean 24.2% (11.9%-36.5% 95% CI). 20.9% of the patients received guideline-recommended preceding non-invasive image guided testing. The use of CA was adherent to the European and German guideline recommendations in 20.4% and 25.4%, respectively. In multivariate-analysis, arterial hypertension and prior revascularization were predictors of guideline non-adherence. These are the first prospective clinical data which demonstrated an overall low degree of guideline-adherence in the use of CA in patients with suspected CCS in the German health care setting. To improve adherence rates, the availability of and access to non-invasive image guided testing needs to be strengthened. (German Clinical Trials Registry DRKS00015638 - Registration Date: 19.02.2019).