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Guidelines versus reality: is coronary stent application in three-vessel disease standard or the exception?

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Abstract

The national guidelines for treatment of chronic coronary heart disease (CHD) recommend surgical coronary aortic bypass grafting (CABG) rather than percutaneous coronary intervention (PCI) for patients with a coronary three-vessel disease. The epidemiology of three-vessel CHD and data about the application of different revascularisation strategies raise suspicion of deviation from the guidelines in the treatment of those patients. Claims data containing records of almost 10 million patients of the largest German statutory health insurance fund (Techniker Krankenkasse) were utilised to measure adherence to the guidelines for treatment of groups of patients with one-, two-, and three-vessel CHD, respectively. The impact of age, sex, and comorbidity on each patient’s revascularisation procedure was investigated as well. There was no significant difference in the rate of PCI between the groups. In conclusion, the hypothesis that patients with a coronary three-vessel disease are not always treated according to the recommendations of the national guidelines could not be disproved by this study. Finally, the results of this study suggest that the best revascularisation strategy for each patient with two- and three-vessel disease should be decided upon by an interdisciplinary discussion between both cardiologists and cardiac surgeons.

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Authors and Affiliations

  1. Wissenschaftliches Institut der Techniker Krankenkasse (WINEG), Bramfelder Straße 140, 22305, Hamburg, Germany

    Roland Linder & F. Verheyen

  2. Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159, Hannover, Germany

    J. Zeidler & J.-M. Graf von der Schulenburg

  3. Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    A. Haverich & T. Schilling

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  1. Roland Linder
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  2. J. Zeidler
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  4. J.-M. Graf von der Schulenburg
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Correspondence to Roland Linder.

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All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. The authors R. Linder and F. Verheyen declare a potential conflict of interest in terms of the guidelines of the International Committee of Medical Journal Editors because of their affiliation to the Techniker Krankenkasse.

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There was no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

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Linder, R., Zeidler, J., Verheyen, F. et al. Guidelines versus reality: is coronary stent application in three-vessel disease standard or the exception?. Eur J Health Econ 19, 821–830 (2018). https://doi.org/10.1007/s10198-017-0924-4

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  • DOI: https://doi.org/10.1007/s10198-017-0924-4

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