Document Detail

Assessing the association of appropriateness of coronary revascularization and clinical outcomes for patients with stable coronary artery disease.
MedLine Citation:
PMID:  23062534     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The study assessed the appropriateness of coronary revascularization in Ontario, Canada, and examined its association with longer-term outcomes.
BACKGROUND: Although appropriate use criteria for coronary revascularization have been developed to improve the rational use of cardiac invasive procedures, it is unknown whether greater adherence to appropriateness guidelines is associated with improved clinical outcomes in stable coronary artery disease.
METHODS: A population-based cohort of stable patients undergoing cardiac catheterization was assembled from April 1, 2006, to March 31, 2007. The appropriateness for coronary revascularization at the time of coronary angiography was retrospectively adjudicated using the appropriate use criteria. Clinical outcomes between coronary revascularization and medical treatment without revascularization, stratified by appropriateness categories, were compared.
RESULTS: In 1,625 patients with stable coronary artery disease, percutaneous coronary intervention or coronary artery bypass grafting was only performed in 69% who had an appropriate indication for coronary revascularization. Coronary revascularization was associated with a lower adjusted hazard of death or acute coronary syndrome (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.42 to 0.88) at 3 years compared with medical therapy in appropriate patients. The rate of coronary revascularization was 54% in the uncertain category and 45% in the inappropriate category. No significant difference in death or acute coronary syndrome between coronary revascularization and no revascularization in the uncertain category (HR: 0.57; 95% CI: 0.28 to 1.16) and the inappropriate category (HR: 0.99; 95% CI: 0.48 to 2.02) was observed.
CONCLUSIONS: Using the appropriateness use criteria, we identified substantial underutilization and overutilization of coronary revascularization in contemporary clinical practice. Underutilization of coronary revascularization is associated with significantly increased risks of adverse outcomes in patients with appropriate indications.
Dennis T Ko; Helen Guo; Harindra C Wijeysundera; Madhu K Natarajan; A Dave Nagpal; Christopher M Feindel; Kori Kingsbury; Eric A Cohen; Jack V Tu;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-10-10
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  60     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-02     Completed Date:  2013-01-09     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1876-84     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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MeSH Terms
Cohort Studies
Coronary Artery Disease / diagnosis,  epidemiology*,  surgery*
Follow-Up Studies
Middle Aged
Percutaneous Coronary Intervention / standards,  trends*
Population Surveillance / methods
Retrospective Studies
Treatment Outcome
Grant Support
MOP 102487//Canadian Institutes of Health Research
Comment In:
J Am Coll Cardiol. 2013 May 14;61(19):2024   [PMID:  23501386 ]
J Am Coll Cardiol. 2013 May 14;61(19):2024-5   [PMID:  23501383 ]
J Am Coll Cardiol. 2012 Nov 6;60(19):1885-7   [PMID:  23062539 ]

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