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


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.
From the University at Albany, State University of New York (E.L.H., Z.S., K.C.); Johns Hopkins University, Baltimore, MD (G.W.); Mayo Clinic, Rochester, MN (D.R.H.); Boston Medical Center, MA (A.K.J.); United Health Services, Binghamton, NY (N.J.S.); Albany Medical Center, NY (F.J.V.); Mt. Sinai Medical Center, New York, NY (S.S.); and St. Joseph's Health System, Atlanta, GA (S.B.K.).
Edward L
EL
Hannan
Zaza
Z
Samadashvili
Kimberly
K
Cozzens
Gary
G
Walford
David R
DR
Holmes
Alice K
AK
Jacobs
Nicholas J
NJ
Stamato
Ferdinand J
FJ
Venditti
Samin
S
Sharma
Spencer B
SB
King
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D017410:Practice Guidelines as Topic; D012040:Regional Health Planning; D012042:Registries
angiography; coronary disease; registries