Hospital Variability in the Rate of Finding Obstructive Coronary Artery Disease at Elective, Diagnostic Coronary Angiography
Key result
Hospital rates of finding obstructive CAD average ~45% and link to patient selection strategies.
- n=565,504
Why the study?
The rate of finding obstructive coronary artery disease at elective coronary angiography varies and the extent of hospital variability was not well described.
Population
565,504 patients without prior MI or revascularization undergoing elective coronary angiography at 691 U.S. hospitals
Comparison
Hospitals with varying rates of finding obstructive CAD at elective coronary angiography
Design
Retrospective analysis using CathPCI Registry data from 2005 to 2008
Authors
Discussion
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Implication
Observational study reveals substantial hospital variation in obstructive coronary artery disease detection during elective angiography, suggesting inconsistent preprocedural patient selection.
Key Points
- To assess hospital-level variation in the diagnostic yield of obstructive coronary artery disease among patients undergoing elective diagnostic coronary angiography.
- Examined registry data from hospitals performing elective diagnostic coronary angiography in patients without prior myocardial infarction or revascularization.
- Calculated hospital-level risk-standardized rates of finding obstructive coronary artery disease after adjusting for patient clinical risk factors and pretest probability.
- Substantial hospital-level variation existed in the proportion of elective coronary angiographies that revealed obstructive coronary artery disease.
- Differences in hospital diagnostic yield persisted after adjusting for patient demographics, clinical comorbidities, and noninvasive test results.
Study Design
Type
Observational (n=565,504)
Multicenter
Yes
PICO
P
Population
565,504 patients without prior myocardial infarction or revascularization undergoing elective coronary angiography at 691 U.S. hospitals.
E
Exposure / Comparator
Elective coronary angiography
O
Primary Outcome
Rate of finding obstructive CAD (any major epicardial vessel stenosis ≥ 50%)
Cite This Study
Douglas et al. (2011) conducted an observational in Suspected coronary artery disease (n=565,504). Elective coronary angiography was evaluated on Rate of finding obstructive CAD (any major epicardial vessel stenosis ≥ 50%). The rate of finding obstructive CAD at elective coronary angiography varied considerably among hospitals, ranging from 23% to 100% (median 45%), and was associated with patient selection strategies.