Prioritization of invasive coronary angiogram for deserving patients with chronic coronary syndrome (CCS) using an Angiogram Eligibility Scoring (AES) system - A Clinical Audit

Type of funding sources: None.

Many patients with CCS are usually referred for invasive treatment early on first come first serve basis. Proper clinical assessment of the severity of symptoms and optimization of the medical therapy lack before referral for invasive therapy due to increased workload and less man power. Patients with non-limiting symptoms are noticed to receive invasive therapy over medical therapy more. Recent ISCHAEMIA trial showed that invasive therapy is not associated with reduction in adverse ischaemic events compared to optimal medical therapy in CCS. Therefore, We implemented a scoring system to identify high risk CCS patients to receive invasive therapy

Angiogram eligibility scoring (AES) is given to patients according to age, gender, atherosclerotic risk factors, symptom profile, stress test findings and the history of myocardial infarction. Similar numbers of patients who underwent invasive angiography through first come first serve basis group and AES group over three consecutive months are compared. Patients in the AES group were called for invasive angiogram according to score in descending order. Each group of patients were analyzed for cardiometabolic risk factors, anginal symptoms, ejection fraction, angiography findings and revascularization plan.

Patients came for invasive angiogram through AES had significant risk factors such as diabetes and dyslipidaemia (P<0.01). Limiting symptoms (Class 3-4 angina) and strongly positive stress test (P<0.01) are significantly high in AES group than first come first serve group. Ejection fraction is normal range in AES group (P<0.01). No significant difference found in the significant LMCA (>50%) plaque disease, severe (>70%) LAD and proximal LAD disease frequency, complexity in coronary artery disease and revascularization strategies between two groups (P>0.01).

AES system facilitated us to prioritize patients with limiting symptoms, strongly positive stress test and multiple atherosclerotic risk factors who would benefit from early invasive angiogram and revascularization over other patients with non-limiting symptoms and without non-invasive investigation before invasive angiography.