The ESC Registry on Chronic Ischemic Coronary Disease

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1 EURObservational Research Programme The ESC Registry on Chronic Ischemic Coronary Disease Prof. Fausto J. Pinto, FESC, FACC, FASE, FSCAI Immediate Past-President, ESC University Hospital Sta Maria University of Lisbon, Portugal Thank you to Prof. Aldo Maggioni

2 Executive Committee Members Michel Komajda Chairman, FR Francesco Cosentino, Sweden Roberto Ferrari, IT Aldo Maggioni, IT Gabriel Steg, FR Luigi TAVAZZI, IT Marco Valgimigli, CH

3 Background 1/2 Atherosclerosis is a systemic disease The three main manifestations are: Coronary artery disease Lower extremity artery disease Cerebrovascular disease Changing environment(procedures/management). We need: RECENT data (last ESC survey 2005)... in a broad spectrum of patients with CVD... and across ESC countries In order to

4 Background 2/2 1. Characterize contemporary CAD/PAD patients in terms of Clinical profile Management 2. Identify potential gaps between practice and evidence based management. 3. Identify geographical variations 4. Determine short/long-term prognoses and their determinants.

5 CICD Registry International prospective observational longitudinal registry Pilot Phase Long-Term Phase APR 2013 DEC 2014 SEPT 2015 MAR Patients Patients 3- YEAR FOLLOW-UP

6 CICD Pilot Registry: Design Cohort 1: NSTE-ACS Urgently revascularised Enrolment: cath lab N = 755 Cohort 2: Chronic CAD Electively revascularised Enrolment: cath lab N = 933 Cohort 3: Chronic CAD Not revascularised Enrolment: general hospital N = 531 Cohort 4: PAD All revascularised Enrolment: cath lab N = 201

7 doi: /eurheartj/ehv437 eurheartj.oxfordjournals.org

8 Demographics & Baseline Characteristics 1/3 Cohorts Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) P-value N of patients Age at inclusion in years, Mean±SD 66.6± ± ± ± ± Female Gender % SBP in mmhg, Mean±SD 136.5± ± ± ± ± Diabetes mellitus % < Smoking status % < Hypertension % Hypercholesterolemia % < SD = Standard Deviation

9 Demographics & Baseline Characteristics 2/3 Cohorts Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) P-value N of patients Previous NSTE ACS % < Previous STEMI ACS % < Previous stable CAD % < Previous revascularization PCI/CABG % Previous peripheral revascularization % Previous cerebrovascular disease % < <0.0001

10 Demographics & Baseline Characteristics 3/3 Cohorts Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) P-value N of patients History of atrial fibrillation < COPD % Chronic kidney disease % Malignancy SD = Standard Deviation

11 Investigations during Admission/Consultation or within One Year Cohorts Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) P-value N of patients S-Creatinine in mg/dl, Mean±SD 1.15± ± ± ± ± Fasting glucose in mg/dl, Mean±SD ± ± ± ± ±55.68 < Total cholesterol in mg/dl, Mean±SD 169.9± ± ± ± ±46.8 < LDL in mg/dl, Mean±SD 101.7± ± ± ± ±38.7 < SD = Standard Deviation

$8 LV ejection fraction (in %), Mean±SD 52.5 ±11.3 50.8 ±10.6 52.7 ±11.1 54.3 ±12.3 54.6 ±11.6 Exercise Test, % 21.2 7.0 24.3 43.9 0.0 Holter Monitoring, % 14.5 13.7 9.1 28.0 7.0 Cardiac CT, % 2.0 0.$

12 Stress Tests Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) N of patients Echocardiogram performed, % LV ejection fraction (in %), Mean±SD 52.5 ± ± ± ± ±11.6 Exercise Test, % Holter Monitoring, % Cardiac CT, % Cardiac MRI, % Myocardial Scintigraphy, % MRI= Magnetic Resonance Imaging

13 Drug Treatments before Hospital Admission or Consultation 1/2 Cohorts Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) P-value N of patients ACE-1, % < ARB, % < ACE-I/ARBs, % < Betablockers, % < Statins, % < ASA, % < DHP Calcium channel blockers, % Non-DHP Calcium channel blockers, % < Amiodarone, % ACE-I = Angiotensin Converting Enzyme Inhibitor; ARBs = Angiotensin II Receptor Blockers; MRAs = Mineralocorticoid Receptor Antagonists; DHP = Dihydropyridine; ASA = Acetylsalicylic acid

14 Drug Treatments before Hospital Admission or Consultation 2/2 Cohort All NSTEMI (1) Elective PCI (2) Stable CAD (3) PAD (4) P-value N of patients Diuretics, % < MRAs, % Nitrates, % Ivabradine, % Ranolazine, % Insulin, % < Oral antidiabetics, % Oral Anticoagulants, % < Clopidogrel, % < Other anti-platelet agents excluding Clopidogrel, %

Drug Treatments: Prescription rate at discharge Before admission or consultation At discharge 82.9 80.2 92.7 90.

15 Drug Treatments: Prescription rate at discharge Before admission or consultation At discharge ACE-I/ARB BETA BLOCKERS STATINS ASA CLOPIDOGREL Other antiplatelet agents

16 Comparison of patients enrolled in the CICD Pilot (2015) and the EHS (2005) 1/2 Cohorts CICD PILOT 2015 EHS 2005 N of patients Age at inclusion in years, Mean±SD 66.6± ±11 % Male Medical history Diabetes mellitus % Dyslipidaemia (%) Hypertension (%) Previous cerebrovascular Disease (%) Malignancy (%) CICD= Chronic Ischaemic Cardiovascular Disease; EHS= Euro Heart Survey * CICD: before/during hospitalization. EHS: during hospitalization /planned. Exercise test (76) / stress imaging (18).

17 Comparison of patients enrolled in the CICD Pilot (2015) and the EHS (2005) 2/2 Cohorts CICD PILOT 2015 EHS 2005 Investigations Echocardiography (%) Ischemia stress tests (%)* 50 stable CAD / 37 elective PCI 76 / 18 Treatment at discharge ACE Betablockers Statins Aspirin Nitrates Calcium channel blockers CICD= Chronic Ischaemic Cardiovascular Disease; EHS= Euro Heart Survey * CICD: before/during hospitalization. EHS: during hospitalization /planned. Exercise test (76) / stress imaging (18).

18 Limitations Center selection on a voluntary basis Medical history recorded by investigator report Heterogeneity across cohorts inherent to study design Sample size inadequate for assessment of geographic variations

19 Conclusion 1/2 Patients enrolled in the CICD Pilot were older, had more CV risk factors and more comorbidities than reported in the previous European survey (Daly, 2005). Important differences in the clinical profile of the four cohorts were observed. Investigations remain suboptimal: #70% had an echocardiogram 50% (stable CAD) and 37% (elective PCI) only had an assessment of myocardial ischemia. Use of new imaging modalities was marginal.

20 Conclusion 2/2 Use of ACE-I, statins and ASA was higher than previously reported, and increased at discharge. Use of beta blockers was higher, whereas use of nitrates was lower than in the 2005 survey. Limited use of new anti-anginal drugs. Overall: Use of recommended procedures remains suboptimal Improvement in secondary prevention.

21 CICD LT registry Objectives Characterize contemporary CICD patients in terms of: Demographic characteristics Clinical profiles Management and diagnostic-therapeutic processes according to the clinical profiles as well as identifying gaps (and possibly their causes) between current routine treatment and evidence-based treatment recommended by ESC guidelines. To determine short- and long-term outcomes and their determinants in this population of patients.

22 CICD LT registry Patient Population Study population: All consecutive patients with CICD either scheduled for an elective revascularisation procedure or visited on an ambulatory basis by participating centres. Main Inclusion criteria: Patients either undergoing an elective revascularisation procedure or seen for a routine follow-up visit Patients presenting with documented CICD, defined as: Previous STEMI OR Previous NSTE ACS OR Previous coronary revascularisation OR Patients with stable coronary artery disease, defined as: Effort-induced angina or rest angina with documented myocardial ischaemia detected by exercise test or any stress imaging or documented >50% stenosis in at least 1 major coronary artery on coronary angiography Asymptomatic ischaemia with a documented >50% stenosis in at least one major coronary artery on coronary angiography Patients with NO ACS in the previous 30 days Number of targeted enrolled patients = 15,000 overall with at least 60 patients/centre

23 CICD LT registry Study Design Patient Follow up at 1 year, 2 years & 3 years after enrolment Types of centres: The total number of centres in each participating country will be split according to the proportion of existing centres With a catheterization laboratory Without a catheterization laboratory

24 CICD LT registry Enrolment Timelines Enrolment is on going End of recruitment is targeted until the end of targeted enrolment of pts, expected Q One year FU end of data collection: exp. Q Two year FU end of data collection: exp. Q Three Year FU end of data collection: exp. Q4 2021

25 CICD LT registry Enrolment Status 1 Countries 22 countries agreed to participate 18 countries have enrolled patients 103 contributing centres (132 confirmed participation) 3,478 patients enrolled overall (1,818 in Oct > 91% more) High participation from Russia: 31 confirmed vs 23 active centres enrolling 755 pts, mostly since October 2016 Egypt started Nov 2016: 1 active centre 71 pts more centres soon enrolment increase soon

26 CICD LT registry Enrolment Status 2 Ukraine newly involved Belarus reactivated Turkey participation pending

27 Thank you for your attention

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