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Titolo:
Hypothetical ratings of coronary angiography appropriateness: are they associated with actual angiographic findings, mortality, and revascularisationrate? The ACRE study
Autore:
Hemingway, H; Crook, AM; Banerjee, S; Dawson, JR; Feder, G; Magee, PG; Wood, A; Philpott, S; Timmis, A;
Indirizzi:
Kensington & Chelsea & Westminster Hlth Author, Dept Res & Dev, London W2 6LX, England Kensington & Chelsea & Westminster Hlth Author London England W2 6LX and Barts & London NHS Trust, Cardiac Directorate, London E2 9JX, England Barts & London NHS Trust London England E2 9JX e, London E2 9JX, England Univ London Queen Mary & Westfield Coll, St Bartholomews & Royal London Med Sch, Dept Gen Practice & Primary Care, London E1 4NS, England Univ LondonQueen Mary & Westfield Coll London England E1 4NS S, England
Titolo Testata:
HEART
fascicolo: 6, volume: 85, anno: 2001,
pagine: 672 - 679
SICI:
1355-6037(200106)85:6<672:HROCAA>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
BYPASS GRAFT-SURGERY; NEW-YORK-STATE; ARTERY DISEASE; CHEST PAIN; CARDIOLOGY;
Keywords:
coronary artery disease; coronary angiography; coronary artery bypass graft; appropriateness of coronary revascularisation;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Hemingway, H Kensington & Chelsea & Westminster Hlth Author, Dept Res & Dev, 50 Eastbourne Terrace, London W2 6LX, England Kensington & Chelsea & Westminster Hlth Author 50 Eastbourne Terrace London England W2 6LX
Citazione:
H. Hemingway et al., "Hypothetical ratings of coronary angiography appropriateness: are they associated with actual angiographic findings, mortality, and revascularisationrate? The ACRE study", HEART, 85(6), 2001, pp. 672-679

Abstract

Objective - To determine whether ratings of coronary angiography appropriateness derived by an expert panel on hypothetical patients are associated with actual angiographic findings, mortality, and subsequent revascularisation in the ACRE (appropriateness of coronary revascularisation) study. Design - Population based, prospective study. The ACRE expert panel rated hypothetical clinical indications as inappropriate, uncertain, or appropriate: before recruitment of a cohort of real patients. Setting - Royal Hospitals Trust, London, UK. Participants - 3631 consecutive patients undergoing coronary angiography (no exclusion criteria). Main outcome measures-Angiographic findings, mortality (n = 226 deaths), and revascularisation (n = 1556 procedures) over 2.5 years of follow up. Results - The indications for coronary angiography were rated appropriate in 2253 (62%) patients. 166 (5%) coronary angiograms were performed for indications rated inappropriate, largely for asymptomatic or atypical chest pain presentations. The remaining 1212 (33%) angiograms were rated uncertain,of which 47% were in patients with mild angina and no exercise ECG or in patients with unstable angina controlled by inpatient management. Three vessel disease was more likely among appropriate cases and normal coronaries were more likely among inappropriate cases (p < 0.001). Mortality and revascularisation rates were highest among patients with an appropriate: indication, intermediate in those with an uncertain indication, and lowest in the inappropriate group (log rank p = 0.018 and p < 0.0001, respectively). Conclusion - The ACRE ratings of appropriateness for angiography predictedangiographic findings, mortality, and revascularisation rates. These findings support the clinical usefulness of expert panel methods in defining criteria for performing coronary angiography.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 03:27:38