title: Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease.
abstract: BACKGROUND
  Compared with medical therapy, percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction in patients with stable angina. Therefore, PCI should be guided by refractory anginal symptoms and not just lesion characteristics.
  
  
  OBJECTIVE
  We hypothesized that angiographic lesion characteristics and stress test results would have a greater role in the decision to proceed with PCI than would symptom severity.
  
  
  METHODS
  We performed a retrospective cohort study of patients undergoing elective cardiac catheterization and possible PCI at an academic medical center. Anginal symptoms, optimal medical therapy, antianginal therapy, stress test results, and angiographic lesions (including American College of Cardiology/American Heart Association [ACC/AHA] lesion type) were analyzed. Logistic regression was used to determine predictors of medical management among patients not referred for coronary artery bypass surgery.
  
  
  RESULTS
  Of the 207 patients with obstructive lesions amenable to PCI, 163 underwent PCI and 44 were referred to medical therapy. In the multivariable logistic model, the following variables were associated with medical management: advancing age (odds ratio [OR] per 1 year: 0.94, 95% confidence interval [CI]: 0.91-0.98), chronic kidney disease (OR: 0.23, 95% CI: 0.06-0.95), distal location (OR: 0.21, 95% CI: 0.09-0.48), and ACC/AHA type C lesion (OR: 0.08, 95% CI: 0.03-0.22). There was no association with sex, race, symptoms, optimal medical therapy, maximal antianginal therapy, referral status, or type of interventional cardiologist (academic vs private practice).
  
  
  CONCLUSIONS
  For patients undergoing cardiac catheterization for stable angina, the decision to proceed to PCI vs medical management appears to depend largely on patient and angiographic characteristics, but not on symptoms or ischemia. Distal and high-risk lesions (ACC/AHA type C) are more often referred for medical therapy.
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.|Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors: Auras R
authors: AR
authors: Atreya
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.
authors: Senthil K
authors: SK
authors: Sivalingam
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.|Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors: Sonali
authors: S
authors: Arora
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.|Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors: Mohammad Amin
authors: MA
authors: Kashef
authors: Faculty and Resident Development, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.
authors: Janice
authors: J
authors: Fitzgerald
authors: Division of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, Massachusetts.
authors: Paul
authors: P
authors: Visintainer
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.|Department of Internal Medicine, Tufts University School of Medicine, Boston, Massachusetts.
authors: Amir
authors: A
authors: Lotfi
authors: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Michael B
authors: MB
authors: Rothberg
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D006328:Cardiac Catheterization; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents