Abstract 13206: Relationship Between Appropriateness of Elective Coronary Angiography and Diagnostic Yield for Obstructive Coronary Artery Disease
Introduction: There is variation in the use and diagnostic yield of invasive coronary angiography in chronic stable ischemic heart disease. The 2012 Appropriate Use Criteria for Diagnostic Catheterization (AUC) was developed to facilitate the more rational use of this invasive test. However, there is a paucity of data on the validity of the AUC in improving the utility of angiography.
Hypothesis: We tested whether higher appropriateness ratings of diagnostic catheterization based on the AUC are associated with a higher proportion of obstructive CAD.
Methods: We used the Cardiac Care Network registry, a population based registry of patients in Ontario, Canada, undergoing elective angiography for suspected stable ischemic heart disease from October 1, 2008, to September 30, 2011. Patients with prior revascularization or myocardial infarction were excluded. We restricted the indications to patients with suspected stable ischemic heart disease. Appropriateness scores for the index angiogram were categorized as appropriate, inappropriate, and uncertain. We compared the relationship between appropriateness category and the presence of obstructive CAD.
Results: From our final cohort of 48,336 patients, 58.2% of patients were classified as appropriate, 10.8% as inappropriate, and 31.0% as uncertain. Overall, 45.5% of the patients had obstructive CAD. Patients with appropriate indications for angiography were had a significantly higher proportion of obstructive CAD (52.9%) compared to those with inappropriate or uncertain indications (30.9% and 36.7%, respectively; p<0.001). Higher appropriateness category was also associated with higher rates of left main or triple vessel disease and with a higher proportion of patients who were subsequently revascularized (Table 1).
Conclusions: Our study lends support to the AUC by showing a clear relationship between appropriateness category of elective angiography and the presence of obstructive CAD.
Author Disclosures: M.M. Mohareb: None. F. Qui: None. W.J. Cantor: None. K.J. Kingsbury: None. D.T. Ko: None. H.C. Wijeysundera: None.
- © 2014 by American Heart Association, Inc.