It’s time to make changes to the angiography appropriate-use criteria (AUC), according to a new Sunnybrook Health Sciences Centre study published in the Annals of Internal Medicine. It uncovered that just over half of the patients considered appropriate had obstructive coronary artery disease (CAD) and about 31 percent of the patients considered inappropriate, in fact, did suffer from obstructive CAD.

The researchers assessed 48,336 patients from 18 hospitals in Ontario, Canada, with stable ischemic heart disease or angina who underwent an angiogram from October 2008 to September 2011. The physicians used the AUC developed in 2012 and deemed about 58 percent of the patients appropriate, about 11 percent inappropriate and 31 percent uncertain.

Ultimately, 45.5 percent of the patients who underwent angiograms had obstructive CAD. The study stated that this “raises concerns about the ability of the AUC to guide clinical decision-making.”
“Typically we associate ‘appropriateness’ with angiograms revealing obstructive coronary artery disease, with patients going on to receive subsequent revascularization such as a stent or bypass surgery,” Dr. Harindra Wijeysundera, principal investigator and interventional cardiologist with Sunnybrook’s Schulich Heart Centre, said in a statement. “Our findings suggest that it may be worth reassessing criteria to help guide clinical practice, and improve patient health outcomes in a cost-effective manner.”

But since the study only assessed patients who underwent angiograms, the researchers are limited in forming conclusions about overuse and underuse by commenting on the appropriateness scores of patients who didn't receive the exam. “Our hope is that these findings will encourage future study to examine the appropriateness criteria to assist clinicians in deciding which patients are good candidates for angiography,” Wijeysundera, said in a statement.

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