Medical Management and Diagnostic Testing among Stable Angina Patients in India: The STable Angina obseRvational (STAR) Registry.
OBJECTIVE
To study the practice pattern in the management of patients with stable angina (SA) in India.


METHODS
The Stable Angina obseRvational Registry (STAR) prospectively enrolled patients provisionally diagnosed with SA by non-interventional practicing internists in India. Patients were followed for 3 months after enrollment to assess medical treatment, diagnostic management, and interventional treatment of coronary artery disease (CAD). At the study conclusion, a statistical analysis retrospectively categorized patients not at risk of CAD by the Morise-Jalisi scale though this was not part of the study protocol.


RESULTS
Between January and May 2012, 2079 patients were enrolled at 131 centres. Mean age was 57 ± 11 years, 62% were men, and 40% had a history of diabetes. Over 90% of patients completed follow-up visit, >85% received statins and antiplatelet medications, >70% received beta blockers, and >60% received angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. Diagnostic testing rates were low: 93% for electrocardiogram, 44% echocardiogram, 42% chest radiography, 12% stress test, and 8% underwent noninvasive CT or invasive coronary angiography, of which, 86% had abnormal results. After the study, the Morise-Jalisi probability of CAD was intermediate in 42% and high in 51% of patients. Only 3.4% of all patients had coronary revascularization.


CONCLUSIONS
In a large cohort of Indian patients with SA, disease severity and probability of CAD were high. Clinicians used evidence-based care for medical management, but underutilized diagnostic testing. Patients with SA in India need to be risk-stratified for probability and severity of CAD and, if indicated, receive additional diagnostic testing.
Department of Cardiology, Breach Candy Hospital, Mumbai, Maharashtra, India.
Dev
D
Pahlajani
Department of Cardiology, Fortis Escorts Heart Institute, New Delhi, India.
Upendra
U
Kaul
Department of Cardiology, B.M. Birla Heart Research Center, Kolkata, West Bengal, India.
Anil
A
Mishra
Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India.
Ajit
A
Mullasari
Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
Jps
J
Sawhney
Department of Cardiology, Stress Test Clinic, Mukund Hospital, Mumbai, Maharashtra, India.
Ramesh
R
Dargad
Department of Cardiology, Health Harmony, Mumbai, Maharashtra, India.
Ketan
K
Mehta
Clinical Department, Medtronic, Inc., Santa Rosa, CA, USA.
Sandeep
S
Brar
Clinical Department, Medtronic, Inc., Mumbai, Maharashtra, India.
Rajesh
R
Radhakrishnan
Clinical Department, Medtronic, Inc., Santa Rosa, CA, USA.
Dennis
D
McMahon
Clinical Department, Medtronic, Inc., Santa Rosa, CA, USA.
Sherif
S
Ibrahim
Clinical Department, Medtronic, Inc., Mumbai, Maharashtra, India.
Haresh
H
Sachanandani
Department of Cardiology, Sahara Hospital, Lucknow, Uttar Pradesh, India Received; 04.02.2015; Accepted: 23.03.2015.
Nakul
N
Sinha