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Is Elective Coronary Angiography Overused?
According to data from a large registry, less than half of patients who undergo elective invasive testing have obstructive coronary artery disease.
Coronary angiography exposes patients to procedural risks and substantial radiation; most would agree that we should avoid the procedure in patients who are unlikely to require further intervention. To find out how often patients referred for elective coronary angiography are found not to have obstructive coronary artery disease (CAD), investigators for the CathPCI Registry of the National Cardiovascular Data Registry assessed the diagnostic yield (prevalence of obstructive CAD) at 663 participating sites. Obstructive CAD was defined as 
50% stenosis of the left main coronary artery or 70% stenosis of a major epicardial or branch vessel.
Of patients who underwent elective diagnostic catheterization (about 20% of all procedures), 38% had obstructive CAD. If the definition of obstructive CAD was expanded to 50% stenosis in any vessel, the prevalence increased to only 41%. An increase in diagnostic yield from 2004 (36.8%) to 2008 (38.8%) was significant but very small. Almost 70% of the patients undergoing elective coronary angiography had positive findings on resting electrocardiography, echocardiography, computed tomography, or stress testing; however, these data were only available as a composite.
Comment: In this national study, the diagnostic yield of elective coronary angiography was remarkably low: only 38%. However, an angiogram's results do not tell us whether it was appropriately ordered. Because the noninvasive testing variable included a wide range of procedures — from resting electrocardiography to stress testing — we cannot speculate from the data how many catheterizations could have been avoided. Nonetheless, these results suggest room for improvement and underscore the importance of implementing evidence-based appropriateness criteria for coronary angiography.
Published in Journal Watch Cardiology March 10, 2010
Citation(s):
Patel MR et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010 Mar 11; 362:886.
- Medline abstract (Free)
Brenner DJ. Medical imaging in the 21st century — Getting the best bang for the rad. N Engl J Med 2010 Mar 11; 362:943.
- Medline abstract (Free)
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- Coronary angiography
Suresh P Amin, Retired and in India, 11 Mar 2010 8:20 AM EST
Nothing new as in India patients and doctors know. They are told that are sitting on “time bomb” a phrase... [more] - Harms
Daniel Class, 11 Mar 2010 8:20 AM EST
So with this data we can calculate the number harmed "The overall risk of Major complications with left heart catheterization... [more] - CONSPIRACY
SAFOIN KADI, kadi cardiovascular clinic, 12 Mar 2010 11:40 AM EST
the FDA is blocking the use of contrast echo which is proved in many studies as being sensitive and specific... [more] - Statistic vs individual
FV Delacruz, 15 Mar 2010 10:02 AM EST
The result of this research would support the no coverage by insurances of the study. However, how we will know... [more]
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