The appropriateness of use of percutaneous transluminal coronary angioplasty in Spain

Background: The rapid increase in the number of percutaneous transluminal c oronary angioplasty (PTCA) procedures performed in Spain in recent years ra ises questions about how appropriately this procedure is being used. To exa mine this issue, we studied the appropriateness of use of PTCA in Spanish p atients and factors associated with inappropriate use. Methods: We applied criteria for the appropriate use of PTCA developed by an expert panel of Sp anish cardiologists and cardiovascular surgeons to a random sample of 1913 patients undergoing PTCA in Spain in 1997. The patients were selected throu gh a two-step sampling process, stratifying by hospital type (public/privat e) and volume of procedures (low/medium/high). We examined the association between inappropriate use of PTCA and different clinical and sociodemograph ic factors. Results: Overall, 46% of the PTCA procedures were appropriate, 31% were uncertain and 22% were inappropriate. Two factors contributing to inappropriate use were patients' receipt of less than optimal medical thera py and their failure to undergo stress testing. Institutional type and volu me of procedures were not significantly related with inappropriate use. Con clusions: One of every five PTCA procedures in Spain is done for inappropri ate reasons. Assuring that patients receive optimal medical therapy and und ergo stress: testing when indicated could contribute to more appropriate us e of PTCA. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.