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. 1997 Mar;77(3):219–224. doi: 10.1136/hrt.77.3.219

The appropriateness of intention to treat decisions for invasive therapy in coronary artery disease in The Netherlands.

A P Meijler 1, H Rigter 1, S J Bernstein 1, J K Scholma 1, J McDonnell 1, A Breeman 1, J B Kosecoff 1, R H Brook 1
PMCID: PMC484685  PMID: 9093037

Abstract

OBJECTIVE: To determine the appropriateness of intention to treat decisions concerning coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) for patients with coronary artery disease in The Netherlands. DESIGN: Prospective study of intention to treat decisions using a computerised expert system. SETTING: "Presentation" sessions in 10 tertiary referral heart centres in 1992. PATIENTS: 3207 consecutive patients: 1618 CABG and 1589 PTCA candidates. MAIN OUTCOME MEASURE: Percentage of invasive treatment decisions rated appropriate, uncertain, or inappropriate by the expert system. RESULTS: PTCA decisions were common for patients with one-vessel disease and CABG decisions for patients with three-vessel and left main disease. PTCA decisions outnumbered CABG decisions in acute myocardial infarction. Of CABG decisions, 84% were rated appropriate, 12% uncertain, and 4% inappropriate. The proportions for PTCA decisions were 39% appropriate, 31% uncertain, and 29% inappropriate. Type C lesion was the main determinant of inappropriateness of PTCA decisions. If type C lesions were downgraded to type A/B lesions the rate of inappropriate PTCA decisions dropped to 6%. CONCLUSIONS: Clinicians in tertiary referral centres in The Netherlands favoured CABG if vessel disease was extensive or involved the left main artery, and PTCA for patients with less extensive disease and with acute myocardial infarction. Few CABG decisions were inappropriate. The main determinant of inappropriateness of PTCA decisions was its intended use in patients with type C lesions.

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Selected References

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  1. Bell M. R., Berger P. B., Bresnahan J. F., Reeder G. S., Bailey K. R., Holmes D. R., Jr Initial and long-term outcome of 354 patients after coronary balloon angioplasty of total coronary artery occlusions. Circulation. 1992 Mar;85(3):1003–1011. doi: 10.1161/01.cir.85.3.1003. [DOI] [PubMed] [Google Scholar]
  2. Bengtson A., Herlitz J., Karlsson T., Brandrup-Wognsen G., Hjalmarson A. The appropriateness of performing coronary angiography and coronary artery revascularization in a Swedish population. JAMA. 1994 Apr 27;271(16):1260–1265. [PubMed] [Google Scholar]
  3. Bernstein S. J., Kosecoff J., Gray D., Hampton J. R., Brook R. H. The appropriateness of the use of cardiovascular procedures. British versus U.S. perspectives. Int J Technol Assess Health Care. 1993 Winter;9(1):3–10. doi: 10.1017/s0266462300002981. [DOI] [PubMed] [Google Scholar]
  4. Brook R. H., Kosecoff J. B., Park R. E., Chassin M. R., Winslow C. M., Hampton J. R. Diagnosis and treatment of coronary disease: comparison of doctors' attitudes in the USA and the UK. Lancet. 1988 Apr 2;1(8588):750–753. doi: 10.1016/s0140-6736(88)91550-4. [DOI] [PubMed] [Google Scholar]
  5. Cowley M. J., Vandermael M., Topol E. J., Whitlow P. L., Dean L. S., Bulle T. M., Ellis S. G. Is traditionally defined complete revascularization needed for patients with multivessel disease treated by elective coronary angioplasty? Multivessel Angioplasty Prognosis Study (MAPS) Group. J Am Coll Cardiol. 1993 Nov 1;22(5):1289–1297. doi: 10.1016/0735-1097(93)90532-6. [DOI] [PubMed] [Google Scholar]
  6. Faxon D. P., Holmes D., Hartzler G., King S. B., Dorros G. ABC's of coronary angioplasty: have we simplified it too much? Interventional Cardiology Committee, Society for Cardiac Angiography and Interventions. Cathet Cardiovasc Diagn. 1992 Jan;25(1):1–3. doi: 10.1002/ccd.1810250102. [DOI] [PubMed] [Google Scholar]
  7. Gray D., Hampton J. R., Bernstein S. J., Kosecoff J., Brook R. H. Audit of coronary angiography and bypass surgery. Lancet. 1990 Jun 2;335(8701):1317–1320. doi: 10.1016/0140-6736(90)91196-h. [DOI] [PubMed] [Google Scholar]
  8. Hilborne L. H., Leape L. L., Bernstein S. J., Park R. E., Fiske M. E., Kamberg C. J., Roth C. P., Brook R. H. The appropriateness of use of percutaneous transluminal coronary angioplasty in New York State. JAMA. 1993 Feb 10;269(6):761–765. [PubMed] [Google Scholar]
  9. Ivanhoe R. J., Weintraub W. S., Douglas J. S., Jr, Lembo N. J., Furman M., Gershony G., Cohen C. L., King S. B., 3rd Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up. Circulation. 1992 Jan;85(1):106–115. doi: 10.1161/01.cir.85.1.106. [DOI] [PubMed] [Google Scholar]
  10. Leape L. L., Hilborne L. H., Park R. E., Bernstein S. J., Kamberg C. J., Sherwood M., Brook R. H. The appropriateness of use of coronary artery bypass graft surgery in New York State. JAMA. 1993 Feb 10;269(6):753–760. [PubMed] [Google Scholar]
  11. McGlynn E. A., Naylor C. D., Anderson G. M., Leape L. L., Park R. E., Hilborne L. H., Bernstein S. J., Goldman B. S., Armstrong P. W., Keesey J. W. Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State. JAMA. 1994 Sep 28;272(12):934–940. [PubMed] [Google Scholar]
  12. Park R. E., Fink A., Brook R. H., Chassin M. R., Kahn K. L., Merrick N. J., Kosecoff J., Solomon D. H. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986 Jul;76(7):766–772. doi: 10.2105/ajph.76.7.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Parsonnet V., Dean D., Bernstein A. D. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989 Jun;79(6 Pt 2):I3–12. [PubMed] [Google Scholar]
  14. Rigter H., Meijler A. P., McDonnell J., Scholma J. K., Bernstein S. J. Indications for coronary revascularisation: a Dutch perspective. Heart. 1997 Mar;77(3):211–218. doi: 10.1136/hrt.77.3.211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ruocco N. A., Jr, Ring M. E., Holubkov R., Jacobs A. K., Detre K. M., Faxon D. P. Results of coronary angioplasty of chronic total occlusions (the National Heart, Lung, and Blood Institute 1985-1986 Percutaneous Transluminal Angioplasty Registry). Am J Cardiol. 1992 Jan 1;69(1):69–76. doi: 10.1016/0002-9149(92)90678-r. [DOI] [PubMed] [Google Scholar]
  16. Stewart J. T., Denne L., Bowker T. J., Mulcahy D. A., Williams M. G., Buller N. P., Sigwart U., Rickards A. F. Percutaneous transluminal coronary angioplasty in chronic coronary artery occlusion. J Am Coll Cardiol. 1993 May;21(6):1371–1376. doi: 10.1016/0735-1097(93)90311-n. [DOI] [PubMed] [Google Scholar]
  17. Winslow C. M., Kosecoff J. B., Chassin M., Kanouse D. E., Brook R. H. The appropriateness of performing coronary artery bypass surgery. JAMA. 1988 Jul 22;260(4):505–509. [PubMed] [Google Scholar]

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