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Related Experiment Videos

Indications for coronary revascularisation: a Dutch perspective

H Rigter1, A P Meijler, J McDonnell

  • 1Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.

Heart (British Cardiac Society)
|March 1, 1997
PubMed
Summary

This study assessed coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) indications. Experts found CABG more appropriate than PTCA for specific patient conditions, aiding guideline development.

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Assessing the appropriateness of revascularization procedures is crucial for optimal patient care.
  • Coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty (PTCA) are common interventions with varying indications.
  • Establishing consensus on procedural appropriateness aids in developing clinical practice guidelines.

Purpose of the Study:

  • To evaluate the appropriateness of indications for CABG surgery and PTCA.
  • To compare the expert panel's preference between CABG, PTCA, and medical treatment across diverse clinical scenarios.
  • To identify factors influencing the appropriateness ratings for these cardiac interventions.

Main Methods:

  • A modified Delphi group judgment process involving 12 interventional cardiologists and cardiac surgeons from Dutch tertiary referral centers.

Related Experiment Videos

  • Panelists rated 1182 model cases, representing various clinical features, on a 1-9 scale for indications of CABG vs. medical, PTCA vs. medical, and CABG vs. PTCA.
  • Analysis focused on inter-panelist agreement, appropriateness scores, and treatment preferences (invasive vs. medical).

    • Main Results:

    • The panel reached agreement on 58.6% of indications, with disagreement on 3.2%.
    • Invasive treatment was preferred in 48.2% of cases, medical treatment in 22.8%, and no clear preference in 29.0%.
    • Coronary artery bypass graft (CABG) was rated more appropriate than percutaneous transluminal coronary angioplasty (PTCA) when compared to medical treatment (35.4% vs. 21.6%, P < 0.001). Appropriateness varied with disease severity and lesion type (e.g., Type C lesions).

    Conclusions:

    • The Delphi panel method provides consistent scores for the appropriateness of medical procedure indications.
    • This approach can serve as a valuable tool in the formulation of clinical practice guidelines for cardiovascular interventions.
    • Expert consensus on indications for CABG and PTCA can help optimize treatment selection and improve patient outcomes.