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Appropriateness of angiography for suspected coronary artery disease

Marita Mohammadshahi1, Sara Emamgholipour Sefiddashti2, Minoo Alipouri Sakha3

  • 1National Institute of Health Research, Group of Payment and Financial Resources of the Health System, Tehran University of Medical Sciences, Tehran, Iran.

Indian Heart Journal
|June 22, 2021
PubMed

Insights

One-quarter of diagnostic catheterizations (DC) for suspected coronary artery disease in Iran were inappropriate, often lacking prior stress tests. Risk factors like high cholesterol and diabetes were linked to this overuse.

Area of Science:

  • Cardiology
  • Health Services Research
  • Medical Informatics

Background:

  • Diagnostic catheterization (DC) is crucial for diagnosing coronary artery disease (CAD).
  • Assessing the appropriateness of DC utilization is essential for optimizing healthcare resources and patient outcomes.
  • Previous studies have highlighted variations in DC use, necessitating localized assessments.

Purpose of the Study:

  • To evaluate the appropriateness of diagnostic catheterization (DC) procedures for patients with suspected coronary artery disease (CAD) in Iran.
  • To identify factors associated with inappropriate DC utilization.

Main Methods:

  • Retrospective analysis of 2458 diagnostic catheterizations (DC) performed between 2012 and 2014.
  • Data collected via Electronic Health Record System and manual file review.
  • Patients categorized into appropriate, uncertain, and inappropriate DC use groups; logistic regression analysis employed.

Main Results:

  • One-quarter (25%) of all DC procedures were deemed inappropriate.
  • 99% of inappropriate DC cases lacked a preceding stress test.
  • Inappropriate DC rates were consistent across different hospitals.
  • Significant associations found between inappropriate DC rates and risk factors including sex, high cholesterol, smoking, chronic heart failure, renal failure, and diabetes.

Conclusions:

  • A substantial proportion of diagnostic catheterizations (DC) for suspected coronary artery disease in Iran were used inappropriately.
  • The absence of prior stress testing is a key indicator of inappropriate DC.
  • Patient-specific risk factors significantly correlate with the likelihood of inappropriate DC utilization.
  • Interventions targeting guideline adherence and appropriate test utilization are warranted to improve DC appropriateness in Iran.

Keywords:
AngiographyAppropriate criteriaCoronary artery disease

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