Coronary anatomical profile should be considered when contemplating treatment for stable CAD

Main conclusions

Revascularisation in patients with stable CAD and high-risk coronary anatomy was associated with improved long-term outcome (all-cause death, MI and combination) compared with conservative therapy.

Type of study

Retrospective registry analysis of 9,016 patients who underwent cardiac catheterisation with stable CAD and high-risk coronary anatomy [3 vessel disease (≥70% stenosis) or LM disease (≥50% stenosis) isolated or not]: 5,487 (61.0%) patients were revascularised within three months following the index coronary angiogram with either CABG surgery (n=3312) or PCI (n=2175), while the remaining 3,529 (39%) were managed conservatively. Inverse probability weighing was used for adjustment of baseline differences.

Main message for clinical practice

Coronary anatomical profile should be considered when revascularisation is contemplated in stable ischemic heart disease. But should a coronary angiography be performed in patients with stable CAD to identify high-risk anatomical features?

Main limitations

Retrospective and observational study, events occurring in the first three months after revascularisation were censored (excluding peri-procedural events) and many patients had a clinical indication for revascularisation according to ESC Clinical Practice Guidelines.