Key result
Coronary revascularization was associated with a significantly lower risk of 1-year major adverse cardiovascular and cerebrovascular events (HR 0.62) compared to medical therapy in patients with appropriate indications.
Why the study?
The Chinese appropriate use criteria (AUC) was released in 2016 to improve revascularization use, but its association with clinical outcomes in stable CAD was unevaluated.
Does coronary revascularization improve 1-year clinical outcomes compared to medical therapy in patients with stable coronary artery disease categorized by Chinese appropriate use criteria?
Cohort (n=6,085)
Yes
Does coronary revascularization improve 1-year clinical outcomes compared to medical therapy in patients with stable coronary artery disease categorized by Chinese appropriate use criteria?
Hazard Ratio: 0.62 (95% CI 0.45–0.86)
Absolute Event Rate: 9.7% vs 15.9%
p-value: p=0.004
Coronary revascularization is associated with a significantly lower risk of 1-year MACCEs compared to medical therapy only in patients with appropriate indications according to the Chinese AUC, supporting the use of these criteria to guide clinical decision-making.
Supports revascularization consideration in indicated patients; leaves open causal confirmation by randomized trials.
BACKGROUND: The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients. METHODS: We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission. RESULTS: From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45-0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52-1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51-1.23; P = 0.308). CONCLUSIONS: In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making. CLINICAL TRIAL REGISTRATION: NCT02880605. https://www.clinicaltrials.gov.
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Lin et al. (2019) conducted a cohort in Stable coronary artery disease (n=6,085). Coronary revascularization vs. Medical therapy was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCEs) at 1 year (HR 0.62, 95% CI 0.45-0.86, p=0.004). Coronary revascularization was associated with a significantly lower risk of 1-year major adverse cardiovascular and cerebrovascular events (HR 0.62) compared to medical therapy in patients with appropriate indications.
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