Silenzi Simona, Scalone Giancarla, di Vito Luca, Mariani Luca, Fraccaro Chiara, Travaglini Francesco, Grossi Pierfrancesco
Cardiology Department, Mazzoni Hospital, via degli Iris 1, 63100 Ascoli Piceno, Italy.
Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, via Giustiniani 2, 35028 Padova, Italy.
Int J Cardiol Heart Vasc. 2020 Nov 30;31:100677. doi: 10.1016/j.ijcha.2020.100677. eCollection 2020 Dec.
Increasing attention is being given to the rational use of invasive procedures. In this study, we aimed to evaluate, among patients referred for coronary angiography, the appropriateness of cardiac catheterization according to the Appropriate Use Criteria (AUC) for diagnostic catheterization and to examine the relationship between the appropriateness and the presence of obstructive coronary artery disease (CAD) and revascularization.
From November 2017 to December 2018, 1188 consecutive patients referred to undergo a diagnostic catheterization were included. They were categorized as having appropriate, uncertain or inappropriate indication, using a database (Melograno System). We restricted our analysis to 9 appropriate indications including acute coronary syndromes, suspected CAD, valvular heart disease, arrhythmias and cardiomyopathy. We restricted the analysis to the subgroup of patients with suspected or known CAD and, among them, we evaluate the rate of CAD and the need for revascularization.
The indications were appropriate in 1017 patients (85.6%), of uncertain appropriateness in 134 (11.3%), and inappropriate in 37 (3.1%). Restricting the analysis to the CAD subgroup, the indications were appropriate in 848 patients (83.3%), of uncertain appropriateness in 133 (13.1%) and inappropriate in 37 (3.6%). The proportion of patients with critical CAD were 75.9%, 44.3% and 29.7% in the appropriate, uncertain and inappropriate categories respectively (p < 0.001). The revascularization rate was 63.1%, 32.2% and 21.6% in the appropriate, uncertain and inappropriate categories respectively (p < 0.001).
Application of AUC is feasible in a community setting. Melograno system is useful to improve patient care.
侵入性操作的合理使用正受到越来越多的关注。在本研究中，我们旨在评估因冠状动脉造影而转诊的患者中，根据诊断性心导管插入术的合理使用标准（AUC）进行心导管插入术的适宜性，并研究适宜性与阻塞性冠状动脉疾病（CAD）的存在及血运重建之间的关系。
纳入2017年11月至2018年12月连续转诊接受诊断性心导管插入术的1188例患者。使用数据库（Melograno系统）将他们分类为有适当、不确定或不适当的适应症。我们将分析限制在9种适当的适应症，包括急性冠状动脉综合征、疑似CAD、瓣膜性心脏病、心律失常和心肌病。我们将分析限制在疑似或已知CAD的患者亚组中，并在这些患者中评估CAD的发生率和血运重建的必要性。
1017例患者（85.6%）的适应症是适当的，134例（11.3%）的适应症适当性不确定，37例（3.1%）的适应症不适当。将分析限制在CAD亚组中，848例患者（83.3%）的适应症是适当的，133例（13.1%）的适应症适当性不确定，37例（3.6%）的适应症不适当。在适当、不确定和不适当类别中，严重CAD患者的比例分别为75.9%、44.3%和29.7%（p<0.001）。在适当、不确定和不适当类别中，血运重建率分别为63.1%、32.2%和21.6%（p<0.001）。
在社区环境中应用AUC是可行的。Melograno系统有助于改善患者护理。
