Appropriate Use of Coronary Angiogram among Service Patients at the UP-Philippine General Hospital in the Year 2019

  • John C. Añonuevo
  • Jaime Alfonso M. Aherrera
  • Lauren Kay M. Evangelista
  • Paula Victoria Catherine Y. Cheng
  • Charlene F. Agustin
  • Marc Denver A. Tiongson
  • Valerie R. Ramiro
  • Felix Eduardo R. Punzalan
Keywords: appropriate use criteria, coronary angiography, cardiac catheterization

Abstract

Rationale. Coronary artery disease (CAD) is the leading cause of death worldwide and coronary angiography
(CA) remains the gold standard for its diagnosis. However, proper patient selection for CA is important to avoid
unnecessary risks and expense. The American College of Cardiology (ACC), with other major organizations, developed Appropriate Use Criteria (AUC) for CA. AUC assist clinicians in decision making on whether to use the tests according to indications and objectively assess if these tests are appropriately utilized. This is the first study to determine the appropriateness of CA performed and the clinical and angiographic profile among adult service patients in UP-PGH.

Objectives. To determine (1) the indications for CA and its appropriateness based on 2012 AUC for Diagnostic
Catheterization by the ACC, (2) the clinical profile of patients who underwent CA among adult service patients at
UP-PGH and (3) the angiographic profile of these patients.

Methods. This cross-sectional study included all CA studies performed on adult service patients from January to
December 2019. Demographic and clinical profiles, non-invasive tests, and angiographic findings were collected. The primary outcome determined was the appropriateness of the indications for each CA performed based on AUC scores. Descriptive analysis using frequencies and mean values with standard deviations were used.

Results. Among the 515 patients included, majority were males, above 50 years of age, with normal eGFR,
presented initially with chest pain, and with a presenting diagnosis of chronic coronary syndrome. Majority of these patients had obstructive CAD (75%), with left anterior descending artery as the most frequently involved vessel. Non-obstructive CAD was found in 11% while normal coronaries were noted in 14% of these patients. Our findings showed that 99.8% of the CA performed were appropriate, of which majority (54%) had an AUC score of A9. STEMI or a suspicion of STEMI, with an A9 score, was the most frequently encountered indication at 33% of the time.

Conclusion. Majority (99%) of the CA studies performed in the PGH cardiac catheterization laboratory for the
year 2019 were executed based on highly appropriate indications (AUC scores A7 to A9) and followed Class I
and II recommendations from guidelines. The allocation of resources is deemed to be well-utilized based on the
data generated from this study.

Published
2021-01-25
Section
Articles

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