Bernstein S J, Hilborne L H, Leape L L, Fiske M E, Park R E, Kamberg C J, Brook R H
RAND, Santa Monica, CA 90406-2398.
JAMA. 1993 Feb 10;269(6):766-9.
To determine the appropriateness of use of coronary angiography in New York State.
Retrospective randomized medical record review.
Fifteen randomly selected hospitals in New York State that provide coronary angiography.
Random sample of 1335 patients undergoing coronary angiography in New York State in 1990.
Percentage of patients who underwent coronary angiography for appropriate, uncertain, or inappropriate indications.
Approximately 76% of coronary angiographies were rated appropriate; 20%, uncertain; and 4%, inappropriate. Inappropriate use did not vary significantly between the elderly (ie, patients aged 65 years and older) and nonelderly, 4.7% and 3.9%, respectively. Although the rate of inappropriate use varied from 0% to 9% among hospitals, the difference was not significant. Rates of appropriateness did not vary by hospital location (upstate vs downstate), volume (fewer than 750 procedures annually or at least 750 procedures annually), teaching status, or whether revascularization was available at the hospital where angiography was performed.
Although coronary angiography was used for few inappropriate indications in New York State, many procedures were performed for uncertain indications in which the benefit and risk were approximately equal or unknown.
确定纽约州冠状动脉造影术的使用合理性。
回顾性随机病历审查。
纽约州随机选取的15家提供冠状动脉造影术的医院。
1990年在纽约州接受冠状动脉造影术的1335例患者的随机样本。
因合理、不确定或不合理指征接受冠状动脉造影术的患者百分比。
约76%的冠状动脉造影术被评定为合理；20%为不确定；4%为不合理。老年人（即65岁及以上患者）和非老年人的不合理使用率分别为4.7%和3.9%，差异无统计学意义。尽管各医院的不合理使用率在0%至9%之间有所不同，但差异不显著。合理使用率不因医院位置（北部地区与南部地区）、手术量（每年少于750例手术或每年至少750例手术）、教学状况或进行造影术的医院是否具备血运重建条件而有所不同。
尽管纽约州冠状动脉造影术用于不合理指征的情况较少，但许多手术是在获益与风险大致相等或未知的不确定指征下进行的。
