Analysis of the Appropriate Use Criteria for Coronary Angiography in Two Cardiology Services of Southern Brazil

Abstract Background: Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization. Objective: To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil. Methods: This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05). Results: Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non-performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment. Conclusion: We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests.

摘要 背景：尽管该主题具有重要临床意义，但巴西国内目前尚无评估2012版心脏诊断导管（cardiac diagnostic catheterization）使用适宜性指南应用情况的相关研究。
目的：分析巴西南部两家医院开展的冠状动脉造影术（coronary angiography）的适宜性。
方法：本研究为多中心横断面研究，对两家医院共计737例冠状动脉造影病例的适应证、检查结果及治疗方案建议进行分析。两家医院分别为多学科三级综合医院（A医院）与三级心血管专科医院（B医院）。本研究纳入择期及急诊冠状动脉造影病例，但排除ST段抬高型急性心肌梗死患者。本研究采用5%作为统计学显著性水准（p<0.05）。
结果：737例冠状动脉造影病例中，63.9%为男性患者，平均年龄为61.6岁。57.1%的病例适应证为急性冠脉综合征（acute coronary syndrome），42.9%为冠状动脉疾病排查。按适宜性分级标准，80.6%的病例被评定为适宜，15.1%为可能适宜，4.3%为罕见适宜。治疗方案建议方面，62.7%的病例采用药物治疗，24.6%采用经皮冠状动脉介入治疗（percutaneous coronary intervention），12.7%采用心肌血管重建手术。在被评定为罕见适宜的病例中，56.2%未行前期功能学检查，21.9%存在重度冠状动脉病变。但无论造影结果如何，该组患者均被建议采用药物治疗。
结论：本研究样本中罕见适宜的冠状动脉造影病例占比偏低，此类病例的指南推荐方案均符合规范，且无患者需要接受血管重建治疗。此类不适宜病例多因未行前期功能学检查所致。