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April 27, 1994

The Appropriateness of Performing Coronary Angiography and Coronary Artery Revascularization in a Swedish Population

Author Affiliations

From the Divisions of Cardiology (Ms Bengtson, Drs Herlitz and Hjalmarson, and Mr Karlsson) and Thoracic Surgery (Dr Brandrup-Wognsen), Wallenberg Laboratory, Department of Heart and Lung Diseases, University of Göteborg (Sweden).

JAMA. 1994;271(16):1260-1265. doi:10.1001/jama.1994.03510400046030

Objective.  —To evaluate the appropriateness of performing coronary angiography and revascularization in a Swedish population.

Design.  —Prospective population study of questionnaires and medical records.

Setting.  —All the hospitals in southwestern Sweden that perform coronary angiography and revascularization.

Patients.  —Random sample of 831 patients (with chronic stable angina) on the waiting list for coronary angiography or revascularization in southwestern Sweden in September 1990.

Main Outcome Measure.  —Percentage of patients referred for coronary angiography or revascularization for appropriate, uncertain, or inappropriate indications.

Results.  —Of the patients referred for angiography, 89% were classified as appropriate, 9% as uncertain, and 2% as inappropriate. The percentages are similar for patients referred for coronary artery bypass graft surgery and for angioplasty (91% and 86%, respectively, classified as appropriate). The majority of patients had chest pain rated as Canadian Cardiovascular Society classes II through IV (93%), despite maximum anti-ischemic therapy in 90% of these patients.

Conclusions.  —Few patients were referred for coronary angiography or revascularization for inappropriate or uncertain indications. The percentage of these patients who are from southwestern Sweden is similar to the percentage recently reported from New York State.(JAMA. 1994;271:1260-1265)