Adherence of catheterization laboratory cardiologists to american college of cardiology/american heart association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery

What happens in actual practice?

Edward L. Hannan, Michael J. Racz, Jeffrey Gold, Kimberly Cozzens, Nicholas J. Stamato, Tia Powell, Mary Hibberd, Gary D Walford

Research output: Contribution to journalArticle

Abstract

Background: The American College of Cardiology and the American Heart Association have issued guidelines for the use of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI) for many years, but little is known about the impact of these evidence-based guidelines on referral decisions. Methods and Results: A cardiac catheterization laboratory database used by 19 hospitals in New York State was used to identify treatment (CABG surgery, PCI, medical treatment, or nothing) recommended by the catheterization laboratory cardiologist for patients undergoing catheterization with asymptomatic/mild angina, stable angina, and unstable angina/non-ST-elevation myocardial infarction between January 1, 2005, and August 31, 2007. The recommended treatment was compared with indications for these patients based on American College of Cardiology/American Heart Association guidelines. Of the 16 142 patients undergoing catheterization who were found to have coronary artery disease, the catheterization laboratory cardiologist was the final source of recommendation for 10 333 patients (64%). Of these 10 333 patients, 13% had indications for CABG surgery, 59% for PCI, and 17% for both CABG surgery and PCI. Of the patients who had indications for CABG surgery, 53% were recommended for CABG and 34% for PCI. Of the patients with indications for PCI, 94% were recommended for PCI. For the patients who had indications for both CABG surgery and PCI, 93% were recommended for PCI and 5% for CABG surgery. Catheterization laboratory cardiologists in hospitals with PCI capability were more likely to recommend patients for PCI than hospitals in which only catheterization was performed. Conclusions: Patients with coronary artery disease receive more recommendations for PCI and fewer recommendations for CABG surgery than indicated in the American College of Cardiology/American Heart Association guidelines.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalCirculation
Volume121
Issue number2
DOIs
StatePublished - Jan 2010
Externally publishedYes

Fingerprint

American Heart Association
Percutaneous Coronary Intervention
Cardiology
Coronary Artery Bypass
Catheterization
Guidelines
Transplants
Cardiologists
Coronary Artery Disease
Stable Angina
Unstable Angina
Cardiac Catheterization

Keywords

  • AHA/ACC guidelines
  • Coronary artery bypass surgery
  • Percutaneous coronary intervention
  • Procedure indications

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Adherence of catheterization laboratory cardiologists to american college of cardiology/american heart association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery : What happens in actual practice? / Hannan, Edward L.; Racz, Michael J.; Gold, Jeffrey; Cozzens, Kimberly; Stamato, Nicholas J.; Powell, Tia; Hibberd, Mary; Walford, Gary D.

In: Circulation, Vol. 121, No. 2, 01.2010, p. 267-275.

Research output: Contribution to journalArticle

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abstract = "Background: The American College of Cardiology and the American Heart Association have issued guidelines for the use of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI) for many years, but little is known about the impact of these evidence-based guidelines on referral decisions. Methods and Results: A cardiac catheterization laboratory database used by 19 hospitals in New York State was used to identify treatment (CABG surgery, PCI, medical treatment, or nothing) recommended by the catheterization laboratory cardiologist for patients undergoing catheterization with asymptomatic/mild angina, stable angina, and unstable angina/non-ST-elevation myocardial infarction between January 1, 2005, and August 31, 2007. The recommended treatment was compared with indications for these patients based on American College of Cardiology/American Heart Association guidelines. Of the 16 142 patients undergoing catheterization who were found to have coronary artery disease, the catheterization laboratory cardiologist was the final source of recommendation for 10 333 patients (64{\%}). Of these 10 333 patients, 13{\%} had indications for CABG surgery, 59{\%} for PCI, and 17{\%} for both CABG surgery and PCI. Of the patients who had indications for CABG surgery, 53{\%} were recommended for CABG and 34{\%} for PCI. Of the patients with indications for PCI, 94{\%} were recommended for PCI. For the patients who had indications for both CABG surgery and PCI, 93{\%} were recommended for PCI and 5{\%} for CABG surgery. Catheterization laboratory cardiologists in hospitals with PCI capability were more likely to recommend patients for PCI than hospitals in which only catheterization was performed. Conclusions: Patients with coronary artery disease receive more recommendations for PCI and fewer recommendations for CABG surgery than indicated in the American College of Cardiology/American Heart Association guidelines.",
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AU - Powell, Tia

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KW - AHA/ACC guidelines

KW - Coronary artery bypass surgery

KW - Percutaneous coronary intervention

KW - Procedure indications

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