Appropriateness of coronary revascularization for patients without acute coronary syndromes
Edward L Hannan1, Kimberly Cozzens, Zaza Samadashvili
1University at Albany, State University of New York, Albany, NY 12144, USA. elh03@health.state.ny.us
Insights
Coronary revascularization appropriateness varies significantly. While most coronary artery bypass graft (CABG) surgeries were appropriate, a substantial portion of percutaneous coronary interventions (PCI) were inappropriate or lacked sufficient data for rating.
Area of Science:
- Cardiology
- Health Services Research
- Interventional Cardiology
Background:
- The American College of Cardiology Foundation (ACCF) and other societies developed joint appropriateness criteria for coronary revascularization.
- These criteria aim to guide the appropriate use of procedures like PCI and CABG.
Purpose of the Study:
- To evaluate the appropriateness of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in New York.
- Focus on patients without acute coronary syndrome (ACS) or prior CABG surgery.
Main Methods:
- Utilized data from New York patients who underwent CABG or PCI without ACS/prior CABG in 2009-2010.
- Assessed procedure appropriateness based on ACCF criteria.
- Examined inter-hospital variation in inappropriateness ratings.
Main Results:
- For CABG (n=8,168 rated patients), 90.0% were appropriate, 1.1% inappropriate, and 8.6% uncertain.
- For PCI (n=33,970 eligible), 28% lacked sufficient data for rating.
- Among rated PCI patients, only 36.1% were appropriate, while 14.3% were inappropriate and 49.6% uncertain.
- Inappropriate PCI cases often involved 1-2 vessel disease without proximal LAD involvement and minimal medical therapy.
Conclusions:
- CABG appropriateness was high (1% inappropriate) for patients without ACS/prior CABG.
- PCI appropriateness was considerably lower (14% inappropriate) in the same patient group.
- A significant proportion of PCI patients (28%) lacked adequate noninvasive testing data for appropriateness assessment.
Objectives:
The purpose of this study was to determine appropriateness of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery performed in New York for patients without acute coronary syndrome (ACS) or previous CABG surgery.
Background:
The American College of Cardiology Foundation (ACCF) and 6 other societies recently published joint appropriateness criteria for coronary revascularization.
Methods:
Data from patients who underwent CABG surgery and PCI without acute coronary syndrome or previous CABG surgery in New York in 2009 and 2010 were used to assess appropriateness and to examine the variation across hospitals in inappropriateness ratings.
Results:
Of the 8,168 patients undergoing CABG surgery in New York without ACS/prior CABG who could be rated, 90.0% were appropriate for revascularization, 1.1% were inappropriate, and 8.6% were uncertain. Of the 33,970 PCI patients eligible for rating, 28% lacked sufficient information to be rated. Of the patients who could be rated, 36.1% were appropriate, 14.3% were inappropriate, and 49.6% were uncertain. A total of 91% of the patients undergoing PCI who were classified as inappropriate had 1- or 2-vessel disease without proximal left anterior descending artery disease and had no or minimal anti-ischemic medical therapy.
Conclusions:
For patients without ACS/prior CABG, only 1% of patients undergoing CABG surgery who could be rated were found to be inappropriate for the procedure according to the ACCF appropriateness criteria, but 14% of the PCI patients who could be rated were found to be inappropriate, and 28% lacked enough noninvasive test information to be rated.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations