Evaluation of Inappropriate Coronary Revascularization Procedures according to the New Classification in a Cardiovascular Tertiary Referral Center

Mariano Albertal, Alfonsina Candiello, Fernando Cura, Marcelo Trivi, Jorge Thierer, Lucio Padilla, Gerardo Nau, Daniel Navia, Jorge Belardi

Abstract


Background

Inappropriate use of revascularization may be potentially harmful to patients and generate unwarranted costs to the health care system. Recently, the members of an expert panel conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered.

Objectives

To identify the proportion of inappropriate coronary revascularization procedures –percutaneous (PTCA) and surgical (CABG) – in a cardiovascular tertiary referral center according to appropriateness criterion.

Material and Methods

We consecutively included all patients referred to our center for coronary angiography from January to May 2009 with a significant coronary stenosis (≥ 70%) who underwent percutaneous or surgical revascularization, and evaluated the rate of inappropriate revascularization according to appropriateness criterion recently published.

Results

From a total of 568 coronary angiographies, 404 (71.2%) had at least a coronary stenosis ≥70%; 81 patients underwent CABGS (20%) and 295 PTCA (73%). In these 376 revascularized patients, the indication was considered inappropriate in 15 (4%), all of them in the PTCA group (15/295; 5%), while only 2 patients with multivessel disease (n=172, 1.2%) underwent inappropriate revascularization.

Conclusions

In a cardiovascular tertiary referral center, the proportion of inappropriate coronary revascularization procedures 

(percutaneous or surgical) was low. Appropriateness criterion may be an applicable tool for decision-making in patients with coronary artery disease and for quality control in the departments of cardiology.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar