Real-world implementation of ESC guidelines in chronic coronary syndromes: Insights from the EURECA registry with a focus on Italian practice.

Authors

Nazario Carrabba, Andrea Igoren Guaricci, Mattia Amico, Riccardo Liga, Tomaž Podlesnikar, Marta Cvijić, Marcelo Haertel Miglioranza, Sara Seitun, Alberto Clemente, Alexey Sumin, João Vitola, Antti Saraste, Christian Paunonen, Ching-Hui Sia, Filipp Paleev, Leyla Elif Sade, Jose Luis Zamorano, Natallia Maroz-Vadalazhskaya, Mirjana Sredojević, Constantinos Anagnostopoulos, Filipe Macedo, Juhani Knuuti, Thor Edvardsen, Bernard Cosyns, Steffen E Petersen, Julien Magne, Gianni Andreozzi, Valentina Lorenzoni, Bogdan A Popescu, Victoria Delgado, Alessia Gimelli, Gianluca Pontone, Danilo Neglia, EURECA investigators

Published in

International journal of cardiology. Pages 134784. Sep 15, 2026. Epub Sep 15, 2026.

Abstract

The EURECA registry showed that 2019 ESC guideline adoption (GA) for management of Chronic Coronary Syndromes is suboptimal regarding the use of diagnostic tests. The present sub-analysis compared Italian cohort (IC) versus non-Italian cohorts (NIC) and explored Italian regional differences.
Patients were grouped into NIC and IC, this further stratified in Northern, Central, and Southern regions. GA was assessed for the choice of first diagnostic test (Endpoint-A) and for the overall diagnostic pathway (Endpoint-B). Quality-of-life, additional diagnostic test and MACE were assessed at 6-month.
Among 4262 patients, 38.4% (1636) were enrolled in Italy (May-2019/March-2020). GA was suboptimal in both cohorts but higher in Italy (p < 0.001 for Endpoint-A and B). In IC vs. NIC exercise-ECG and coronary-CT-angiography were used more frequently (39.6% vs. 25.5%, 35.0% vs. 20.2%; p < 0.001) while stress-imaging and invasive coronary angiography (ICA) were less used (39.4% vs. 45.9%, 22.9% vs. 34.5%; p < 0.001 for both). Exercise-ECG and ICA remained the main drivers of non-GA in both cohorts. Final diagnosis of obstructive-CAD was less frequent in IC than NIC (19.9% vs. 26.9%; p < 0.001), with similar rate of ischemia detection (19. % vs. 18.9%; p = 0.74) and revascularization (12.8% vs. 14.0%; p = 0.27). GA, obstructive-CAD, ischemia, treatment changes and revascularizations were low in Italian-southern region. Six-month MACE was low and not associated with GA in both cohorts.
The rate of GA was higher in IC as compared with the NIC but still suboptimal, especially in Italian-southern region. Non-GA was mainly driven by exercise-ECG and ICA as first test use.

PMID:
42744020
Bibliographic data and abstract were imported from PubMed on 16 Sep 2026.

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