Ann Intern Med. 2015 Apr 21;162(8):549-56. doi: 10.7326/M14-1889.
The use of invasive coronary angiography in stable ischemic heart disease (IHD) varies widely.
To validate the 2012 appropriate use criteria for diagnostic catheterization by examining the relationship between the appropriateness of cardiac catheterization in patients with suspected stable IHD and the proportion of patients with obstructive coronary artery disease (CAD) and subsequent revascularization.
Population-based, observational, multicenter cohort study.
The Cardiac Care Network, a registry of all patients having elective angiography at 18 hospitals in Ontario, Canada, between 1 October 2008 and 30 September 2011.
Persons without prior coronary revascularization or myocardial infarction who had angiography for suspected stable CAD.
Appropriateness scores were ascertained by using data collected at the time of the index angiography and were categorized as appropriate, inappropriate, or uncertain.
Among the final cohort of 48 336 patients, 58.2% of angiographic studies were classified as appropriate, 10.8% were classified as inappropriate, and 31.0% were classified as uncertain. Overall, 45.5% of patients had obstructive CAD. In patients with appropriate indications for angiography, 52.9% had obstructive CAD, with 40.0% undergoing revascularization. In those with inappropriate indications, 30.9% had obstructive CAD and 18.9% underwent revascularization; in those with uncertain indications, 36.7% had obstructive CAD and 25.9% had revascularization. Although more patients with appropriate indications had obstructive CAD and underwent revascularization (P < 0.001), a substantial proportion of those with inappropriate or uncertain indications had important coronary disease.
Data were not available on whether symptoms were atypical.
Despite the association between appropriateness category and obstructive CAD, this study raises concerns about the ability of the appropriate use criteria to guide clinical decision making.
Canadian Institutes of Health Research.
在稳定性缺血性心脏病（IHD）中，侵入性冠状动脉造影的使用差异很大。
通过检查疑似稳定性 IHD 患者心脏导管插入术的适宜性与阻塞性冠状动脉疾病（CAD）患者的比例以及随后的血运重建之间的关系，验证 2012 年诊断性导管插入术的适宜性标准。
基于人群的、观察性的、多中心队列研究。
加拿大安大略省 18 家医院的心脏护理网络（Cardiac Care Network），在 2008 年 10 月 1 日至 2011 年 9 月 30 日期间进行选择性血管造影的所有患者的注册登记处。
无先前冠状动脉血运重建或心肌梗死且因疑似稳定性 CAD 而行血管造影术的患者。
通过在指数血管造影术时收集的数据确定适宜性评分，并将其归类为适宜、不适宜或不确定。
在最终的 48336 例患者队列中，58.2%的血管造影术被归类为适宜，10.8%被归类为不适宜，31.0%被归类为不确定。总体而言，45.5%的患者存在阻塞性 CAD。在有适当血管造影指征的患者中，52.9%有阻塞性 CAD，其中 40.0%接受了血运重建。在不适当指征的患者中，30.9%有阻塞性 CAD，18.9%接受了血运重建；在不确定指征的患者中，36.7%有阻塞性 CAD，25.9%接受了血运重建。尽管有更多有适当指征的患者存在阻塞性 CAD 并接受了血运重建（P<0.001），但相当一部分有不适当或不确定指征的患者存在重要的冠状动脉疾病。
没有关于症状是否不典型的数据。
尽管适宜性类别与阻塞性 CAD 之间存在关联，但这项研究对适宜性标准指导临床决策的能力提出了质疑。
加拿大卫生研究院。
