A.K. Gitt, F. Towae, C. Juenger, A. Papp, R. Zahn, U. Zeymer, J. Senges For the STAR-Study-Group Herzzentrum Ludwigshafen, Germany

Transcription

1 Impact of Interventional Versus Conservative Approach on 5-Year-Mortality of Patients With Stable Angina and Documented Coronary Artery Disease in Clinical Practice: Results of the STAR-Registry A.K. Gitt, F. Towae, C. Juenger, A. Papp, R. Zahn, U. Zeymer, J. Senges For the STAR-Study-Group Herzzentrum Ludwigshafen, Germany ESC Congress 2012, Munich, Germany

2 Disclosure Declaration Dr. Anselm K. Gitt has received grant / research support from: Abbott, Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, Merck, MSD, Pfizer, Roche, Sanofi, Servier, Novartis, Takeda, Daiichi-Sankyo Dr. Anselm K. Gitt has been a consultant for and served on the speakers bureaus of: Amgen, Astra-Zeneca, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Merck, MSD, Novonordisk, Roche, Sanofi, Servier, Novartis, Takeda

3 Reflecting Clinical Practice - Closing the Loop - Gitt AK et al., Eur Heart J, Jan 2010

4 Euro Heart Survey Programme 46 Countries, 1000 Centres, Patients

5 EHS Stable Angina Risk Score Prognosis Daly, Gitt et al., BMJ :

6 ESC-Guideline Angina Algorithm for initial assessment R i s k - S t r a t i f i c a t i o n Fox et al., Eur Heart J :

7 Stable Angina in Clinical Practice - German Registry - Supported by an unrestricted grant of Pfizer Germany

8 STAR - German Registry - German multicenter prospective registry 50 centres enrolling consecutive pts Inclusion criteria Stable angina pectoris Class CCS I-III First angiographic documentation of coronary artery disease (at least one major vessel with stenosis 50%) Exclusion criteria: None

9 Objective of Analysis To examine long-term complications (death / MI / 5 years) in stable CAD patients with primarily invasive versus conservative treatment approach in clinical practice in Germany

10 Stable Angina - Invasive vs Conservative - Consecutive Patients with Stable Angina (1st Dg of CAD) n=2,002 Invasive (PCI / CABG) n=926 (46.3%) Conservative n=1,076 (53.7%) PCI n=894 (96.5%) CABG n=32 (3.5%)

11 Stable Angina - Patients Characteristics - Invasive n=926 Conservative n=1,076 p-value Age (years) <0.001 Female Gender (%) 31.1% 29.0% =0.31 Prior MI (%) 5.9% 10.3% <0.001 Prior Stroke/TIA (%) 4.1% 5.1% =0.28 Diabetes (%) 22.3% 30.0% <0.001 Hypertension (%) 74.0% 73.6% =0.84 Renal Failure (%) 0.7% 0.9% =0.48 PAD (%) 7.7% 11.7% <0.01

12 Stable Angina - Angiographic Findings - Invasive n=926 Conservative n=1,076 p-value 1-Vessel-Dis. 57.1% 32.9% < Vessel-Dis. 30.5% 29.6% = Vessel-Dis. 12.4% 37.5% <0.01 LV-EF<40% 5.2% 10.3% <0.01 Left main 1.6% 16.4% <0.01

13 Stable Angina - Lesions treated - Invasive n=926 Invasive n=926 LAD 54.1% 1-vessel PCI 81.7% CX 19.6% Multi-vessel PCI 18.3% RCA 29.0% Stenting 70.9% Left main 0.1%

14 Stable Angina and CAD - Initial Discharge-Medication - % <0.01 <0.01 ns <0.01 ns p<0.01 ns

15 Stable Angina and CAD - Cumulative 1-Year-Outcome - % =0.10 <0.05 =0.08 =0.15

16 Stable Angina and CAD - Cumulative 5Y - % <0.05 <0.05 <0.05

17 Stable Angina - 5-Year-Survival - 1 Survival of Stable Angina in Germany 0,9 0,8 0,7 0,6 0,5 Days

18 Stable Angina and CAD - Cumulative 5-Year-Outcome - % =0.06 <0.05 =0.11 =0.18

19 Cumulative survival Stable Angina - 5-Year-Survival - 1,00 0,95 0,90 0,85 0,80 0,75 0,70 p-log-rank < 0.05 Invasive Therapy Primary conservative therapy Days after discharge

20 Stable Angina - Predictors of Mortality - Lower Mortality Higher Mortality

21 Stable Angina - Invasive vs Conservative - Patients with invasive approach Were younger Less often had prior MI and other co-morbidities More often had 1-vessel-disease Primary intervention: PCI High rate of PCI and CABG in Germany 46% PCI at index coronary angiography 34.3% PCI in following 5 years 38.3% CABG in following 5 years

22 Stable Angina - Invasive vs Conservative - Primary conservative treatment Change to any intervention in 63.8% PCI 18.3% CABG 53.9% High 5-year mortality 18.9% overall No differences between initial invasive versus conservative treatment (HR 1.03)

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24 EHS Stable Angina Risk Stratification Prognosis Daly, Gitt et al., BMJ :