Appropriateness of Coronary Revascularization for Patients Without Acute Coronary Syndromes

被引:69
作者
Hannan, Edward L. [1 ]
Cozzens, Kimberly
Samadashvili, Zaza
Walford, Gary [2 ]
Jacobs, Alice K. [3 ]
Holmes, David R., Jr. [4 ]
Stamato, Nicholas J. [5 ]
Sharma, Samin [6 ]
Venditti, Ferdinand J. [7 ]
Fergus, Icilma [8 ]
King, Spencer B., III [9 ]
机构
[1] SUNY Albany, Sch Publ Hlth, Rensselaer, NY 12144 USA
[2] Johns Hopkins Univ, Baltimore, MD USA
[3] Boston Med Ctr, Boston, MA USA
[4] Mayo Clin, Rochester, MN USA
[5] United Hlth Serv, Binghamton, NY USA
[6] Med Univ Ohio, Toledo, OH USA
[7] Mt Sinai Med Ctr, New York, NY 10029 USA
[8] Albany Med Ctr, Albany, NY USA
[9] St Josephs Hlth Syst, Atlanta, GA USA
关键词
appropriateness of coronary revascularization; coronary artery disease; percutaneous coronary intervention; BYPASS GRAFT-SURGERY; AMERICAN-COLLEGE; INTERVENTIONS;
D O I
10.1016/j.jacc.2012.01.050
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. (J Am Coll Cardiol 2012;59:1870-6) (C) 2012 by the American College of Cardiology Foundation
引用
收藏
页码:1870 / 1876
页数:7
相关论文
共 17 条
[1]   Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association Task Force guidelines [J].
Anderson, HV ;
Shaw, RE ;
Brindis, RG ;
Klein, LW ;
McKay, CR ;
Kutcher, MA ;
Krone, RJ ;
Wolk, MJ ;
Smith, SC ;
Weintraub, WS .
CIRCULATION, 2005, 112 (18) :2786-2791
[2]   A contemporary overview of percutaneous coronary interventions - The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) [J].
Anderson, HV ;
Shaw, RE ;
Brindis, RG ;
Hewitt, K ;
Krone, RJ ;
Block, PC ;
McKay, CR ;
Weintraub, WS .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (07) :1096-1103
[3]  
[Anonymous], 2006, J Am Coll Cardiol, V47, pe1e121, DOI DOI 10.1016/j.jacc.2005.12.001
[4]   Appropriateness of Percutaneous Coronary Intervention [J].
Chan, Paul S. ;
Patel, Manesh R. ;
Klein, Lloyd W. ;
Krone, Ronald J. ;
Dehmer, Gregory J. ;
Kennedy, Kevin ;
Nallamothu, Brahmajee K. ;
Weaver, W. Douglas ;
Masoudi, Frederick A. ;
Rumsfeld, John S. ;
Brindis, Ralph G. ;
Spertus, John A. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 306 (01) :53-61
[5]   ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article [J].
Eagle, KA ;
Guyton, RA ;
Davidoff, R ;
Edwards, FH ;
Ewy, GA ;
Gardner, TJ ;
Hart, JC ;
Herrmann, HC ;
Hillis, LD ;
Hutter, AM ;
Lytle, BW ;
Marlow, RA ;
Nugent, WC ;
Orszulak, TA ;
Antman, EM ;
Smith, SC ;
Alpert, JS ;
Anderson, JL ;
Faxon, DP ;
Fuster, V ;
Gibbons, RJ ;
Gregoratos, G ;
Halperin, JL ;
Hiratzka, LF ;
Hunt, SA ;
Jacobs, AK ;
Ornato, JP .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2004, 44 (05) :1146-1154
[6]  
Fitch K., 2001, The RAND/UCLA appropriateness method user's manual
[7]   Adherence of Catheterization Laboratory Cardiologists to American College of Cardiology/American Heart Association Guidelines for Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery What Happens in Actual Practice? [J].
Hannan, Edward L. ;
Racz, Michael J. ;
Gold, Jeffrey ;
Cozzens, Kimberly ;
Stamato, Nicholas J. ;
Powell, Tia ;
Hibberd, Mary ;
Walford, Gary .
CIRCULATION, 2010, 121 (02) :267-275
[8]   Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery [J].
Hannan, EL ;
van Ryn, M ;
Burke, J ;
Stone, D ;
Kumar, D ;
Arani, D ;
Pierce, W ;
Rafii, S ;
Sanborn, TA ;
Sharma, S ;
Slater, J ;
DeBuono, BA .
MEDICAL CARE, 1999, 37 (01) :68-77
[9]   THE APPROPRIATENESS OF USE OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN NEW-YORK-STATE [J].
HILBORNE, LH ;
LEAPE, LL ;
BERNSTEIN, SJ ;
PARK, RE ;
FISKE, ME ;
KAMBERG, CJ ;
ROTH, CP ;
BROOK, RH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 269 (06) :761-765
[10]   Temporal Trends in the Use of Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in New York State and Ontario [J].
Ko, Dennis T. ;
Tu, Jack V. ;
Samadashvili, Zaza ;
Guo, Helen ;
Alter, David A. ;
Cantor, Warren J. ;
Hannan, Edward L. .
CIRCULATION, 2010, 121 (24) :2635-2644