Understanding variability in physician ratings of the appropriateness of coronary angiography after acute myocardial infarction

We examined variability in ratings of the appropriateness of coronary angio graphy for 890 clinical scenarios (indications) alter an acute myocardial i nfarction (AMI) from a nine-member multispecialty panel as a function of pa nel characteristics and the attributes of the clinical indications. We docu mented a substantial degree of reliability in the ratings. However, key dif ferences among the experts in terms of both their overall propensity to sco re high and their beliefs regarding the impact of clinical factors on appro priateness were identified. Age, cardiac complications, post-AMI angina, an d noninvasive test results were the clinical factors most strongly related to appropriateness ratings for coronary angiography. Further research on th e effectiveness of coronary angiography in older patients and in patients w ith shock, pulmonary edema, and silent ischemia is needed to improve our kn owledge about the appropriateness of this procedure in these patients. (C) 1999 Elsevier Science Inc.