Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State

Edward L. Hannan, Zaza Samadashvili, Kimberly Cozzens, Gary Walford, David Holmes, Alice K. Jacobs, Nicholas J. Stamato, Ferdinand J. Venditti, Samin Sharma, Spencer B. King

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background-Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC. Methods and Results-New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC for coronary artery disease between 2010 and 2011 for suspected coronary artery disease. Patients were rated by the appropriate use criteria as appropriate, uncertain, and inappropriate for DC. The relationships between various patient characteristics and the appropriateness ratings were examined, along with the relationships between hospital-level inappropriateness, for DC and 2 other hospital-level variables (hospital DC volume and percutaneous coronary intervention inappropriateness). Of the 8986 patients who could be rated for appropriateness, 35.3% were rated as appropriate, 39.8% as uncertain, and 24.9% as inappropriate. Of the 2240 patients rated as inappropriate, 56.7% were asymptomatic/had no previous stress test/had low or intermediate global coronary artery disease risk, 36.0% had a previous stress test with low-risk findings and no symptoms, and 7.3% were symptomatic/had no previous stress test/ had low pretest probability. The median hospital-level inappropriateness rate was 28.5%, with a maximum of 48.8% and a minimum of 8.6%. Hospital-level inappropriateness was not related to hospital volume or inappropriateness for percutaneous coronary intervention. Conclusions-One quarter of patients undergoing DC for suspected coronary artery disease were rated as inappropriate for the procedure, approximately two thirds of these inappropriate patients had no previous stress test, and ̃90% of inappropriate patients with no previous stress test were asymptomatic with low or intermediate global risk scores.

Original languageEnglish (US)
Pages (from-to)19-27
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2014

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Catheterization
Coronary Artery Disease
Exercise Test
Percutaneous Coronary Intervention
Cardiac Catheterization
Databases
Population

Keywords

  • Angiography
  • Coronary disease
  • Registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State. / Hannan, Edward L.; Samadashvili, Zaza; Cozzens, Kimberly; Walford, Gary; Holmes, David; Jacobs, Alice K.; Stamato, Nicholas J.; Venditti, Ferdinand J.; Sharma, Samin; King, Spencer B.

In: Circulation: Cardiovascular Interventions, Vol. 7, No. 1, 01.01.2014, p. 19-27.

Research output: Contribution to journalArticle

Hannan, EL, Samadashvili, Z, Cozzens, K, Walford, G, Holmes, D, Jacobs, AK, Stamato, NJ, Venditti, FJ, Sharma, S & King, SB 2014, 'Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State', Circulation: Cardiovascular Interventions, vol. 7, no. 1, pp. 19-27. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000741
Hannan, Edward L. ; Samadashvili, Zaza ; Cozzens, Kimberly ; Walford, Gary ; Holmes, David ; Jacobs, Alice K. ; Stamato, Nicholas J. ; Venditti, Ferdinand J. ; Sharma, Samin ; King, Spencer B. / Appropriateness of diagnostic catheterization for suspected coronary artery disease in New York State. In: Circulation: Cardiovascular Interventions. 2014 ; Vol. 7, No. 1. pp. 19-27.
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abstract = "Background-Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC. Methods and Results-New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC for coronary artery disease between 2010 and 2011 for suspected coronary artery disease. Patients were rated by the appropriate use criteria as appropriate, uncertain, and inappropriate for DC. The relationships between various patient characteristics and the appropriateness ratings were examined, along with the relationships between hospital-level inappropriateness, for DC and 2 other hospital-level variables (hospital DC volume and percutaneous coronary intervention inappropriateness). Of the 8986 patients who could be rated for appropriateness, 35.3{\%} were rated as appropriate, 39.8{\%} as uncertain, and 24.9{\%} as inappropriate. Of the 2240 patients rated as inappropriate, 56.7{\%} were asymptomatic/had no previous stress test/had low or intermediate global coronary artery disease risk, 36.0{\%} had a previous stress test with low-risk findings and no symptoms, and 7.3{\%} were symptomatic/had no previous stress test/ had low pretest probability. The median hospital-level inappropriateness rate was 28.5{\%}, with a maximum of 48.8{\%} and a minimum of 8.6{\%}. Hospital-level inappropriateness was not related to hospital volume or inappropriateness for percutaneous coronary intervention. Conclusions-One quarter of patients undergoing DC for suspected coronary artery disease were rated as inappropriate for the procedure, approximately two thirds of these inappropriate patients had no previous stress test, and ̃90{\%} of inappropriate patients with no previous stress test were asymptomatic with low or intermediate global risk scores.",
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AU - Samadashvili, Zaza

AU - Cozzens, Kimberly

AU - Walford, Gary

AU - Holmes, David

AU - Jacobs, Alice K.

AU - Stamato, Nicholas J.

AU - Venditti, Ferdinand J.

AU - Sharma, Samin

AU - King, Spencer B.

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N2 - Background-Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC. Methods and Results-New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC for coronary artery disease between 2010 and 2011 for suspected coronary artery disease. Patients were rated by the appropriate use criteria as appropriate, uncertain, and inappropriate for DC. The relationships between various patient characteristics and the appropriateness ratings were examined, along with the relationships between hospital-level inappropriateness, for DC and 2 other hospital-level variables (hospital DC volume and percutaneous coronary intervention inappropriateness). Of the 8986 patients who could be rated for appropriateness, 35.3% were rated as appropriate, 39.8% as uncertain, and 24.9% as inappropriate. Of the 2240 patients rated as inappropriate, 56.7% were asymptomatic/had no previous stress test/had low or intermediate global coronary artery disease risk, 36.0% had a previous stress test with low-risk findings and no symptoms, and 7.3% were symptomatic/had no previous stress test/ had low pretest probability. The median hospital-level inappropriateness rate was 28.5%, with a maximum of 48.8% and a minimum of 8.6%. Hospital-level inappropriateness was not related to hospital volume or inappropriateness for percutaneous coronary intervention. Conclusions-One quarter of patients undergoing DC for suspected coronary artery disease were rated as inappropriate for the procedure, approximately two thirds of these inappropriate patients had no previous stress test, and ̃90% of inappropriate patients with no previous stress test were asymptomatic with low or intermediate global risk scores.

AB - Background-Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC. Methods and Results-New York State's Cardiac Diagnostic Catheterization Database was used to identify patients undergoing DC for coronary artery disease between 2010 and 2011 for suspected coronary artery disease. Patients were rated by the appropriate use criteria as appropriate, uncertain, and inappropriate for DC. The relationships between various patient characteristics and the appropriateness ratings were examined, along with the relationships between hospital-level inappropriateness, for DC and 2 other hospital-level variables (hospital DC volume and percutaneous coronary intervention inappropriateness). Of the 8986 patients who could be rated for appropriateness, 35.3% were rated as appropriate, 39.8% as uncertain, and 24.9% as inappropriate. Of the 2240 patients rated as inappropriate, 56.7% were asymptomatic/had no previous stress test/had low or intermediate global coronary artery disease risk, 36.0% had a previous stress test with low-risk findings and no symptoms, and 7.3% were symptomatic/had no previous stress test/ had low pretest probability. The median hospital-level inappropriateness rate was 28.5%, with a maximum of 48.8% and a minimum of 8.6%. Hospital-level inappropriateness was not related to hospital volume or inappropriateness for percutaneous coronary intervention. Conclusions-One quarter of patients undergoing DC for suspected coronary artery disease were rated as inappropriate for the procedure, approximately two thirds of these inappropriate patients had no previous stress test, and ̃90% of inappropriate patients with no previous stress test were asymptomatic with low or intermediate global risk scores.

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KW - Coronary disease

KW - Registries

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