Obstructive CAD Detection Rates Vary Between Hospitals

Considerable variation in coronary artery disease detection at elective coronary angiography

TUESDAY, Aug. 9 (HealthDay News) -- Significant interhospital variation exists in the rate of detection of obstructive coronary artery disease (CAD) in patients undergoing elective coronary angiography, according to a study published in the Aug. 16 issue of the Journal of the American College of Cardiology.

Pamela S. Douglas, M.D., from the Duke Clinical Research Institute in Durham, N.C., and colleagues examined variations in hospitals' rates of detecting obstructive CAD at elective coronary angiography in patients with no known history of myocardial infarction or revascularization. Data from 565,504 patients undergoing treatment at 691 U.S. hospitals between 2005 and 2008 were taken from the National Cardiovascular Data Registry CathPCI Registry.

The investigators found that the rate of obstructive CAD detection varied from 23 to 100 percent among hospitals. The rates were consistent over time, and when alternative definitions of coronary stenosis were used. Hospitals with lower obstructive CAD detection rates were significantly more likely to perform coronary angiography on those with lower Framingham risk and with no or atypical symptoms. They also had a higher likelihood of performing coronary angiography on younger patients, and those with a negative, equivocal, or unperformed functional status assessment. Hospitals with low obstructive CAD detection rates prescribed aspirin, beta-blockers, platelet inhibitors, and statins significantly less frequently. Detection rates were lower at centers with small-volume catheterization laboratories. There was no correlation between detection rates and hospital ownership or teaching program status.

"The rate of finding obstructive CAD at elective coronary angiography varied considerably among reporting centers and was associated with patient selection and pre-procedure assessment strategies," the authors write.

One of the study authors disclosed financial relationships with the pharmaceutical industry.

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