Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease
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Date
2019-01-05
Authors
Hanrahan, Michael T.
O'Flynn, Anne Marie
McHugh, Sheena M.
Kearney, Peter
Kearney, Patricia M.
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Springer Nature Switzerland AG
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Abstract
Introduction: The American College of Cardiology Foundation (ACCF) with other professional societies developed appropriate use criteria (AUC) for diagnostic coronary angiography. This study aims to examine the appropriate use of elective coronary angiography for patients with suspected stable coronary artery disease in an Irish tertiary referral center. Methods: A retrospective chart review of all elective outpatient diagnostic coronary angiograms performed in Cork University Hospital in 2014 was carried out. Data on demographics, risk factors, clinical presentation, and prior non-invasive investigations were extracted. Each patient was evaluated according to the 2012 ACCF appropriate use criteria and classified as appropriate, uncertain, or inappropriate. Univariable and multivariable logistic regression analysis was performed to investigate the factors that predict patients undergoing appropriate diagnostic coronary angiography. Results: Of 417 elective outpatient diagnostic coronary angiograms, 259 (62%) were included in the analysis. Of these, 108 (42%) were classified as appropriate, 97 (37%) as uncertain, and 54 (21%) as inappropriate. In multivariable analysis, those with private health insurance were more likely to have an appropriate indication for coronary angiogram (OR 2.1, 95% CI 1.2–3.7) as were those with atrial fibrillation (OR 3.9, 95% CI 1.2–12.8). Ever smokers were less likely to have an appropriate indication for coronary angiogram than never smokers (OR 0.5, 95% CI 0.3–0.9). Conclusion: This is the first Irish study to evaluate the appropriate use of elective coronary angiography. Rates were similar to those of studies in other jurisdictions; however, there remains significant potential for quality improvement.
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Keywords
Appropriate use criteria , Cardiac catheterization , Coronary angiography , Quality of health care
Citation
Hanrahan, M. T., O'Flynn, A. M., McHugh, S. M., Kearney, P., Kearney, P. M. (2019) 'Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease', Irish Journal of Medical Science, pp. 1-7. doi:10.1007/s11845-018-1953-4
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© 2019, Royal Academy of Medicine in Ireland. Published by Springer Nature Switzerland AG. This is a post-peer-review, pre-copyedit version of an article published in the Irish Journal of Medical Science. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11845-018-1953-4