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Percutaneous coronary interventions for stable ischemic heart disease in Italy

De Servi, Stefanoa; Olivari, Zoranb; Crimi, Gabrielec; Marino, Marcellod; Alberti, Luca P.a; Tagliabue, Elenae; Leonardi, Sergioc

Journal of Cardiovascular Medicine: November 2019 - Volume 20 - Issue 11 - p 762–767
doi: 10.2459/JCM.0000000000000835
Research articles: Coronary interventions
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Aims Although the benefits of percutaneous coronary interventions (PCIs) in patients with stable chronic ischemic heart disease (SIHD) are controversial, a large number of PCIs are currently performed in SIHD patients, frequently after coronary angiography (ad-hoc procedures), without the use of fractional flow reserve (FFR) to identify patients most likely to benefit from PCI.

Methods Assessment of regional variations in PCI for SIHD performed in Italy in 2017 and correlation of the regional number of PCI per million inhabitants with the use of FFR were performed using the data reported in the registry of the Italian Society of Interventional Cardiology (SICI-GISE) registry for the year 2017.

Results PCI for SIHD accounted for 44.5% of all PCI performed in Italy with large variations among the Italian regions. There was a significant and inverse relationship between the use of FFR and the PCI number per million inhabitants performed for SIHD in the various Italian regions (P = 0.01). In the Veneto region, where local authorities mandated Heart Team reports to select the most appropriate treatment choice in multivessel disease patients, the rate of ad-hoc procedures was significantly lower than the national average.

Conclusion PCI for SIHD patients represent almost half of all procedures currently performed in Italy with regional variations inversely related to physiologic guidance use. The mandatory assessment by the Heart Team to select the most appropriate treatment choice in multivessel disease patients is associated with a significantly lower number of ad-hoc procedures.

aUnita’ di Cardiologia, IRCCS MultiMedica, Milan

bOspedale Riabilitativo ad Alta Specializzazione, Treviso

cFondazione IRCCS Policlinico San Matteo, Pavia

dCardiologia, Ospedale Maggiore, Crema

eUnita’ di Biostatistica, IRCCS MultiMedica, Milan, Italy

Correspondence to Stefano De Servi, MD, FESC, Unita’ di Cardiologia, IRCCS Multimedica, Milan, Italy Tel: +39 02 24209590; e-mail: stefano.deservi@multimedica.it

Received 24 February, 2019

Revised 25 March, 2019

Accepted 28 April, 2019

© 2019 Italian Federation of Cardiology. All rights reserved.