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Assessment of Indications in Interventional Cardiology: Appropriateness and Necessity of Coronary Angiography and Revascularization

Institute of Social and Preventive Medicine, University of Zurich, Sumatrastrasse 30, 8006 Zurich, Switzerland juli{at}ifspm.unizh.ch

Peter Gerstl, MD

Epaminondas Kapetanios, PhD

Institute of Information Systems, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland

Chung-Yol Lee, MD, MPH

Osmund Bertel, MD

Triemli Hospital, Zurich, Switzerland

In this study we present appropriateness and necessity assessments of coronary angiographies and revascularizations to determine adherence to Swiss guidelines by using the computerized second-opinion system (SOS) as a reference. We prospectively compared SOS ratings with ratings of treating cardiologists and surgeons for 203 coronary angiographies and 100 percutaneous transluminal coronary angioplasties. We also retrospectively assessed indications of 103 coronary artery bypass grafts. SOS ratings of appropriate, uncertain, and inappropriate indications for coronary angiography were 85.5%, 10%, and 4.5%, respectively, and 99.5%, 0.5%, and 0%, respectively, for revascularization. Corresponding clinicians' ratings were 95%, 4%, and 1% and 100%, 0%, and 0%, respectively. SOS ratings of necessary, uncertain, and unnecessary indications for angiography were 82.4%, 17.6%, and 0%7, respectively, and 97%, 3%, and 0%, respectively, for revascularization. Corresponding clinicians' values were 88.2%, 10.6%, and 1.2% and 98%, 2%, and 0o, respectively. Significant statistical differences for coronary angiography were found for patients with acute myocardial infarction and for patients within 12 weeks of myocardial infarction. A high accordance between estimated SOS and clinically estimated appropriateness of procedures was found, which might suggest that the guidelines are valid. Regular validation and updating of the guidelines is highlighted. Possible overuse of angiography in patients within 12 weeks of myocardial infarction may need further investigation.

Key Words: Appropriateness • interventional cardiology • quality

American Journal of Medical Quality, Vol. 18, No. 4, 155-163 (2003)
DOI: 10.1177/106286060301800405


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