Ea. Mcglynn et al., COMPARISON OF THE APPROPRIATENESS OF CORONARY ANGIOGRAPHY AND CORONARY-ARTERY BYPASS GRAFT-SURGERY BETWEEN CANADA AND NEW-YORK-STATE, JAMA, the journal of the American Medical Association, 272(12), 1994, pp. 934-940
Objective.-To compare the appropriateness of coronary angiography and
coronary artery bypass graft (CABG) use between the United States and
Canada. Design.-Retrospective randomized medical record review. Settin
g.-All hospitals performing coronary angiography and/or CABG surgery i
n two Canadian provinces (Ontario and British Columbia); in New York S
tate, 15 randomly selected hospitals that provide coronary angiography
and 15 randomly selected hospitals that provide CABG surgery. Patient
s.-All patients were randomly selected. For coronary angiography, 533
patients in Canada and 1333 patients in New York were selected; for CA
BG, 556 patients in Canada and 1336 patients in New York were selected
. Main Outcome Measures.-Percentage of patients in each country who ha
d coronary angiography or CABG for necessary, appropriate, uncertain,
or inappropriate indications as rated by criteria developed separately
in each country and the complications of those procedures. Results.-F
or coronary angiography, 9% of Canadian cases and 10% of New York case
s were rated inappropriate using Canadian criteria compared with 5% an
d 4%, respectively, using US criteria. For CABG, 4% of Canadian cases
and 6% of New York cases were rated inappropriate by Canadian criteria
compared with 3% and 2%, respectively, using US criteria. A lower pro
portion of procedures were performed on persons aged 75 years or older
in Canada than in New York for both coronary angiography (5% vs 11%;
P<.001) and CABG (6% vs 14%; P<.001). Women were also represented in l
ower proportions among angiography cases in Canada than in New York (2
8% vs 35%; P=.023). Canadian patients with left main coronary disease
waited significantly longer between angiography and CABG than did New
York patients (P<.0001). Conclusions.-Rates of inappropriate use of ca
rdiac procedures were low in Canada and New York, which suggests that
the regionalization of cardiac procedures that characterizes both heal
th care systems contributes to better clinical decision making. Differ
ences in the use of cardiac procedures among the elderly in the two co
untries merits further comparative examination.