Assessing Appropriateness of Coronary Angiography: Another Step in Improving Quality
Authors: David P. Faxon
Journal: Annals of Internal Medicine (2008)

Editorials19 August 2008Assessing Appropriateness of Coronary Angiography: Another Step in Improving QualityDavid P. Faxon, MDDavid P. Faxon, MDFrom Brigham and Women's Hospital, Boston, MA 02120.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-4-200808190-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Coronary angiography has been the principal means of assessing coronary disease in patients who may need coronary revascularization (1). Introduced in the 1960s, the test has become one of the most frequently performed procedures in the United States. The American Heart Association estimates that more than 1.3 million procedures were done in 2005, an increase of 342% since 1979 (2). With the phenomenal growth of this expensive test and the small but significant morbidity and mortality associated with it, many have questioned the appropriateness of the present rates of use of the procedure.Over the past 20 years, studies have ...References1. Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. Circulation. 1999;99:2345-57. [PMID: 10226103] MedlineGoogle Scholar2. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al; American Heart Association Statistics Committee. Stroke Statistics Subcommittee. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:25-146. [PMID: 18086926] MedlineGoogle Scholar3. Selby JV, Fireman BH, Lundstrom RJ, Swain BE, Truman AF, Wong CC, et al. Variation among hospitals in coronary-angiography practices and outcomes after myocardial infarction in a large health maintenance organization. N Engl J Med. 1996;335:1888-96. [PMID: 8948565] CrossrefMedlineGoogle Scholar4. Park RE, Fink A, Brook RH, Chassin MR, Kahn KL, Merrick NJ, et al. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986;76:766-72. [PMID: 3521341] CrossrefMedlineGoogle Scholar5. Gibbons RJ, Smith S, Antman E; American College of Cardiology. American College of Cardiology/American Heart Association clinical practice guidelines: Part I: where do they come from? Circulation. 2003;107:2979-86. [PMID: 12814985] CrossrefMedlineGoogle Scholar6. Gibbons RJ, Smith SC, Antman E; American College of Cardiology. American College of Cardiology/American Heart Association clinical practice guidelines: Part II: evolutionary changes in a continuous quality improvement project. Circulation. 2003;107:3101-7. [PMID: 12821590] CrossrefMedlineGoogle Scholar7. Hemingway H, Chen R, Junghans C, Timmis A, Eldridge S, Black N, et al. Appropriateness criteria for coronary angiography in angina: reliability and validity. Ann Intern Med. 2008;149:221-31. LinkGoogle Scholar8. Hemingway H, Crook AM, Feder G, Banerjee S, Dawson JR, Magee P, et al. Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization. N Engl J Med. 2001;344:645-54. [PMID: 11228280] CrossrefMedlineGoogle Scholar9. Zia MI, Goodman SG, Peterson ED, Mulgund J, Chen AY, Langer A, et al. Paradoxical use of invasive cardiac procedures for patients with non-ST segment elevation myocardial infarction: an international perspective from the CRUSADE Initiative and the Canadian ACS Registries I and II. Can J Cardiol. 2007;23:1073-9. [PMID: 17985010] CrossrefMedlineGoogle Scholar10. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee to Update the 1997 Exercise Testing Guidelines. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40:1531-40. [PMID: 12392846] CrossrefMedlineGoogle Scholar11. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients with Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003;107:149-58. [PMID: 12515758] MedlineGoogle Scholar12. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-16. [PMID: 17387127] CrossrefMedlineGoogle Scholar13. Alexander KP, Newby LK, Bhapkar MV, White HD, Hochman JS, Pfisterer ME, et al; Symphony and 2nd Symphony Investigators. International variation in invasive care of the elderly with acute coronary syndromes. Eur Heart J. 2006;27:1558-64. [PMID: 16760200] CrossrefMedlineGoogle Scholar14. Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med. 1997;336:480-6. [PMID: 9017942] CrossrefMedlineGoogle Scholar15. Gibbons RJ, Miller TD, Hodge D, Urban L, Araoz PA, Pellikka P, et al. Application of appropriateness criteria to stress single-photon emission computed tomography sestamibi studies and stress echocardiograms in an academic medical center. J Am Coll Cardiol. 2008;51:1283-9. [PMID: 18371560] CrossrefMedlineGoogle Scholar16. Brindis RG, Douglas PS, Hendel RC, Peterson ED, Wolk MJ, Allen JM, et al. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association. J Am Coll Cardiol. 2005;46:1587-605. [PMID: 16226194] MedlineGoogle Scholar17. Patel MR, Spertus JA, Brindis RG, Hendel RC, Douglas PS, Peterson ED, et al; American College of Cardiology Foundation. ACCF proposed method for evaluating the appropriateness of cardiovascular imaging. J Am Coll Cardiol. 2005;46:1606-13. [PMID: 16226195] CrossrefMedlineGoogle Scholar18. Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006;295:1912-20. [PMID: 16639050] CrossrefMedlineGoogle Scholar19. Smaha LA; American Heart Association. The American Heart Association Get With The Guidelines program. Am Heart J. 2004;148:S46-8. [PMID: 15514634] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Brigham and Women's Hospital, Boston, MA 02120.Disclosures: None disclosed.Corresponding Author: David P. Faxon, MD, Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, 1620 Tremont Street, OBC-3-12N, Boston, MA 02120; e-mail, [email protected]org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAppropriateness Criteria for Coronary Angiography in Angina: Reliability and Validity Harry Hemingway , Ruoling Chen , Cornelia Junghans , Adam Timmis , Sandra Eldridge , Nick Black , Paul Shekelle , and Gene Feder Metrics Cited ByAppropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteriaIntegrazione di sicurezza e qualitàIntegrating Safety and QualityUniversal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in JapanThe Mortality Effects of Cost Containment under Universal Health Insurance: The Japanese Experience 19 August 2008Volume 149, Issue 4Page: 276-278KeywordsAnginaAngiographyClinical trialsCoronary revascularizationExerciseRevascularizationTreatment guidelines ePublished: 19 August 2008 Issue Published: 19 August 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...