Beyond Randomized Clinical Trials: Multi-morbidity, Age and Gender Impact on the Treatment of Coronary Artery Disease

• Main Author: Gudnadottir, Gudny Stella
• Other Authors: Þórarinn Guðnason, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2018
• Subjects: SWEDEHEART; Gender; Multi-morbid older people with complex health needs; Revascularizations; Invasive strategy; Kynferði; Aldraðir; Kransæðasjúkdómar; Fjölveikindi; Doktorsritgerðir; Aged; 80 and over; Coronary Artery Disease; Coronary Angiography; Acute Coronary Syndrome; Hospital Mortality; Propensity Score; Patient Readmission; Coronary Artery Bypass; Percutaneous Coronary Intervention; Registries; Catheterization; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/689

Aims: The purpose of this doctoral research is to investigate the treatment of coronary artery disease in groups that are underrepresented in randomized clinical trials using the SWEDEHEART registry. The more specific aims are: i) to compare the outcomes of coronary angiographies (CA) and percutaneous coronary interventions (PCI) in Iceland, with the outcomes in Sweden; ii) to compare the revascularization rate and complication rate in women and men with acute coronary syndromes (ACS); iii) to compare the outcomes of an invasive strategy to that of a non-invasive strategy in older people with multi-morbidity, complex health needs and ACS; and finally, iv) to study catheterizations in nonagenarians. Methods: Data originated from SWEDEHEART, a collection of cardiology registries used in Iceland and Sweden. i) In Paper I, all CA and PCI performed in Iceland and Sweden in 2007 were compared. ii) Paper II analyzed all consecutive CA between 2007-2011 due to ACS to explore gender differences in revascularization, in-hospital complications and 30-day mortality. iii) Paper III and unpublished data compared one-year outcome following invasive strategy in patients ≥ 70 years with multi-morbidity and complex health needs that were admitted in 2006-2013, due to ACS, to the outcome of a non-invasive strategy. iv) Paper IV enrolled all consecutive nonagenarians undergoing CA or PCI during 2006-2014 and examined indications, treatment decisions and outcomes. Results: i) More CA were performed per capita in Iceland in 2007 than in Sweden, but the overall PCI rate was similar. Stable coronary artery disease was more common as an indication for both CA and PCI in Iceland than in Sweden. The practice of PCI was largely similar in the two countries. One of the differences was the use of radial access; it was used in 1% of catheterizations in Iceland compared to 33% in Sweden. After PCI, the complication rate in the coronary care unit was 8% and 5%, in Iceland and Sweden respectively. ii) In total 34,120 CAs ±PCIs were performed in ...