P1648Potential role of vitamin C intracoronary administration in preventing cardiac injury after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

Abstract

coronary angiography as a means to improve the appropriateness of treatment for patients with stable CAD. Methods: In this prospective, controlled, before-after trial, stable CAD patients with coronary lesion stenosis ≥50% according to elective coronary angiography were consecutively recruited. In phase one, SYNTAX scores were calculated by the treating cardiologists and revascularization decisions were made without feedback from the core laboratory. In phase two, SYNTAX scores were calculated by the core laboratory technician immediately after coronary angiography and provided to their cardiologists in real time to aid in decision-making. The primary outcome is the proportion of treatment strategies deemed inappropriate by the Chinese appropriate use criteria for coronary revascularization. Results: Between August 2016 and September 2017, 3245 patients were enrolled in the trial among 12 participating cardiologists and were assigned to the pre-intervention group (August 2016 to March 2017, n=1525) or the intervention group (March 2017 to September 2017, n=1720). During the intervention period, there was no difference in inappropriate treatment rate compared with the control period (Adjusted odds ratio [OR]: 0.89; 95% confidence interval [CI]: 0.78-1.01; p=0.071). During the intervention period, the proportions of both inappropriate percutaneous coronary intervention (PCI) (Adjusted OR: 0.82; 95% CI: 0.74-0.92; p<0.001) and PCI utilization (Adjusted OR: 0.9; 95% CI: 0.79-0.98; p=0.016) were significantly lower. During the intervention period, the proportion of medical therapy was significantly higher (Adjusted OR: 1.19; 95% CI: 1.03-1.37; p=0.016), and the increased medical therapy did not lead to more inappropriate medical therapy (Adjusted OR: 1.00; 95% CI: 0.76-1.33; p=0.975). Conclusions: Real-time angiographic core lab SYNTAX score feedback failed to reduce the inappropriate treatment decisions, but produced a significant reduction in the proportion of inappropriate PCI and increased the proportion of appropriate medical therapy. This study provides a practical, site-level approach to reduce inappropriate PCI.