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.

Acute Coronary Syndrome Diagnosis &amp; Management Approach in Emergency Department: Literature Review

“…According to American Heart Association recommendations, an ECG should be taken within 10 minutes of the patient's arrival for any complaints that might indicate an ACS. As soon as STEMI in a center for Percutaneous Coronary Intervention (PCI) is verified, the cath lab should be opened (Luciano et al, 2019). Cardiovascular enzymes, particularly troponin and the CK-MB/CK ratio, are crucial for determining if a patient has an NSTEMI or myocardial ischemia without tissue damage (Luciano et al, 2019).…”

Diabetes mellitus and acute coronary syndromes

“…Першим кроком оцінки є ЕКГ, яка допомагає розрізнити ГІМпST, ГІМбпST та нестабільну стенокардію. Правила AHA стверджують, що будь-якому пацієнту з підозрою на ГКС необхідно провести ЕКГ протягом 10 хв після прибуття в лікарняний заклад [31][32][33].…”

Appropriate Use Criteria for Coronary Angiography at Two Hospitals in Southern Brazil: "Doing the Right Things And Doing Things Right"

“…A further interesting finding of Luciano et al 10 relates to the reasons behind the rarely appropriate (inappropriate) category of DC and the decision-making upstream. The higher the frequency of inappropriate DC, the more likely the frequency of further inappropriate interventions, a phenomenon called the "diagnostic-therapeutic cascade".…”

“…In this issue of Arquivos Brasileiros de Cardiologia, Luciano et al 10 present results on the use of AUC for diagnostic catheterization (DC) in Brazil. 10 From May to October 2016, data were obtained for DC performed at two tertiary hospitals (a general hospital vs. a cardiology hospital).…”

“…In this issue of Arquivos Brasileiros de Cardiologia, Luciano et al 10 present results on the use of AUC for diagnostic catheterization (DC) in Brazil. 10 From May to October 2016, data were obtained for DC performed at two tertiary hospitals (a general hospital vs. a cardiology hospital). The authors collected data that allowed appropriateness scores to be assigned for each DC, namely, "appropriate" (7 to 9), "occasionally appropriate" (4 to 6) or "rarely appropriate" (1 to 3).…”