Factors influencing the implementation of percutaneous coronary interventions in patients with acute coronary syndrome in Russia

Abstract

Background: It is important to entirely reveal all patients with acute coronary syndrome (ACS) requiring percutaneous coronary interventions (PCI). Peculiarities of decision making in the network of Russian healthcare system were studied. Aim: To identify clinical patient characteristics associated with PCI performance in patient with ACS. Methods: Data from 65,912 ACS patients (60.5% male) aged 63.2±13.8 years, containing in Russian ACS Registry (2010-2011) were examined. Associations between patients' clinical characteristics and PCI implementation were studied among patients who underwent any type of PCI (ACS-PCI patients) and those who were refused PCI (ACS-nonPCI patients). Twenty eight clinical characteristics, including PCI appropriateness according with ACCF 2012 appropriate use criteria, were analyzed using discrimination analysis (multivariate regression). Exposure variable was PCI implementation. Results: PCI was performed in 13.8% of patients. Among ACS-PCI patients PCI was appropriate in 68.9%. Among ACS-nonPCI patients 42.1% of patients were not eligible for PCI because of contraindications and/or ACCF 2012 criteria (procedure was uncertain or inappropriate). Main clinical factors associated with PCI implementation were ACCF 2012 appropriate use criterion No. 1 (STEMI and 12 hours or less from symptom onset), ST-segment elevation on ECG, male sex. In ACS-nonPCI patients, ACCF 2012 appropriate use criterion No. 11 (UA/NSTEMI and high risk features for short-term risk of death or non-fatal MI), the increase in the age and CHF were significantly associated with not receiving PCI. Conclusions: PCI was more commonly performed in patients with unequivocal STEMI compared to high-risk patients with non-ST elevation ACS, although both of these categories of patients had equal need of PCI. Using of ACCF appropriateness criteria allows clinicians to identify more patients requiring PCI and minimizes inappropriate use of the procedures.