PDG47 Periprocedural Percutaneous Coronary Intervention (PCI) Management in Clinical Practice in Europe

Abstract

Percutaneous coronary intervention (PCIs) are widely practiced in Europe but clinical practice may differ across countries. For this reason, identifying current PCI burden and clinical practice, especially the use of P2Y12 inhibitors, is necessary to understand PCI clinical impact from a health system perspective. A survey of cardiologists and interventional cardiologists from different European countries regarding PCI management practices at their centers was conducted in February 2020. 38 questionnaires were completed (Belgium (n=1), Germany (n=3), Netherlands (n=8), Portugal (n=6), Spain (n=14) and 6 declined to specify). The reported duration of hospital stays (mainly in ICU and cardiovascular units, for 1 - 7 days) following PCI and the occurrence of thrombotic and bleeding events (<1% to 10% and <1% to 20%, respectively) were somewhat variable. Between 8% and 50% of PCIs were described as complex and between 10% and 60% were in high risk patients, mainly due to diabetes. In terms of medication, pre-loading patients with oral P2Y12 inhibitors was considered a good strategy, however between up to 30% of patients didn´t receive any and up to 30% were thought not to be suitable candidates. For bail-out treatment of periprocedural thrombotic events, the GPI tirofiban was the most commonly cited option and often used in pre-loaded patients with oral P2Y12 inhibitors (61%). 29% of respondents reported previous experience using the intravenous P2Y12 inhibitor cangrelor (mostly in STEMI patients) and said they would choose it in up to 50% of complex PCI patients, with fast onset (2 min) and offset of action (duration of effect: 1-2 h) its most-cited added value in the adjunctive treatment in PCI. PCIs have a significant clinical burden in Europe and their clinical management differs across centers and countries. Further studies may be advisable to reveal their economic impact on the health system.