Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State

Coronary angiography and coronary artery bypass graft (CABG) surgery tend to be used appropriately in heart disease patients in Canada and the U.S. Researchers reviewed medical records of 1866 coronary angiography patients, 533 treated in Canada and 1333 treated in New York, and 1892 CABG patients, 556 treated in Canada and 1336 treated in New York. Investigators assessed the appropriateness and short-term outcome of the procedure in each patient. Results revealed that coronary angiography was used inappropriately in 5% of Canadians and 4% of New Yorkers according to U.S. criteria. CABG was used inappropriately in 3% in Canadians and 2% of New Yorkers according to U.S. criteria. Both procedures were performed less often in Canadian patients over age 75 than in their New York counterparts. Patient outcome after coronary angiography revealed that more New Yorkers had less significant blockage of their arteries than Canadians. During CABG, more Canadians had a heart attack than New Yorkers.
Objective.--To compare the appropriateness of coronary angiography and coronary artery bypass graft (CABG) use between the United States and Canada. Design.--Retrospective randomized medical record review. Setting.--All hospitals performing coronary angiography and/or CABG surgery in two Canadian provinces (Ontario and British Columbia); in New York State, 15 randomly selected hospitals that provide coronary angiography and 15 randomly selected hospitals that provide CABG surgery. Patients.--All patients were randomly selected. For coronary angiography, 533 patients in Canada and 1333 patients in New York were selected; for CABG, 556 patients in Canada and 1336 patients in New York were selected. Main Outcome Measures.--Percentage of patients in each country who had coronary angiography or CABG for necessary, appropriate, uncertain, or inappropriate indications as rated by criteria developed separately in each country and the complications of those procedures. Results.--For coronary angiography, 9% of Canadian cases and 10% of New York cases were rated inappropriate using Canadian criteria compared with 5% and 4%, respectively, using US criteria. For CABG, 4% of Canadian cases and 6% of New York cases were rated inappropriate by Canadian criteria compared with 3% and 2%, respectively, using US criteria. A lower proportion of procedures were performed on persons aged 75 years or older in Canada than in New York for both coronary angiography (5% vs 11%; P