ArticleCirculation2008
Diagnostic-therapeutic cascade revisited: coronary angiography, coronary artery bypass graft surgery, and percutaneous coronary intervention in the modern era.
Article in Circulation, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02748603 (Appropriateness of Coronary Angioplasty in PAtients With isCHEmic Heart Disease), which is not on this map. Cited by 27 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Appropriateness of Coronary Angioplasty in PAtients With isCHEmic Heart Disease
Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention.Circulation. Cardiovascular quality and outcomes · 2012Pooled it
- Frequency, predictors, and consequences of crossing over to revascularization within 12 months of randomization to optimal medical therapy in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial.Circulation. Cardiovascular quality and outcomes · 2013Trial
- Review
- Assessment of atherosclerotic plaque burden: comparison of AI-QCT versus SIS, CAC, visual and CAD-RADS stenosis categories.The international journal of cardiovascular imaging · 2024Article
- Atherosclerosis Imaging Quantitative Computed Tomography (AI-QCT) to guide referral to invasive coronary angiography in the randomized controlled CONSERVE trial.Clinical cardiology · 2023Article
- The Merits, Limitations, and Future Directions of Cost-Effectiveness Analysis in Cardiac MRI with a Focus on Coronary Artery Disease: A Literature Review.Journal of cardiovascular development and disease · 2022Review
- Observational
- Cardiac computed tomographic angiography after abnormal ischemia test as a gatekeeper to invasive coronary angiography.The international journal of cardiovascular imaging · 2022Article
- Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes.Scientific reports · 2019Article
- Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spendingf.American economic journal. Economic policy · 2019Article
- Electrocardiograms in Low-Risk Patients Undergoing an Annual Health Examination.JAMA internal medicine · 2017Article
- A study of noninvasive fractional flow reserve derived from a simplified method based on coronary computed tomography angiography in suspected coronary artery disease.Biomedical engineering online · 2017Article
- Regional variation in patient selection and treatment for lower extremity vascular disease in the Vascular Quality Initiative.Journal of vascular surgery · 2017Article
- Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease.Clinical cardiology · 2016Observational
- Clinical exome sequencing in neurologic disease.Neurology. Clinical practice · 2016Review
- Patient selection for diagnostic coronary angiography and hospital-level percutaneous coronary intervention appropriateness: insights from the National Cardiovascular Data Registry.JAMA internal medicine · 2014Article
- Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes.JAMA internal medicine · 2014Article
- Computed fractional flow reserve (FFTCT) derived from coronary CT angiography.Journal of cardiovascular translational research · 2013Review
- Understanding of regional variation in the use of surgery.Lancet (London, England) · 2013Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundThere is wide geographic variation in the use of coronary revascularization in the United States. Rates are closely related to rates of coronary angiography. We assessed the relationship between coronary angiography and coronary artery revascularization by procedure type (coronary artery bypass graft surgery or percutaneous coronary intervention). METHODS AND
resultsUsing Part B claims for a 20% sample of the Medicare population, we calculated population-based rates of testing and treatment by region, using events identified in Part B claims as the numerator and the total number of Medicare beneficiaries residing in the area as the denominator and adjusting for regional differences in demographic characteristics with the indirect method. Cardiac catheterization rates varied substantially across regions, from 16 to 77 per 1000 Medicare beneficiaries. The relationship between coronary angiography rates and total coronary revascularization rates was strong (R(2)=0.84). However, there was only a modest association between coronary angiography rates and coronary artery bypass graft surgery rates (R(2)=0.41) with the suggestion of a threshold effect. The association between coronary angiography rates and percutaneous coronary intervention rates was strong (R(2)=0.78) and linear.
conclusionsThe diagnostic-therapeutic cascade for coronary artery disease differs by therapeutic intervention. For coronary artery bypass graft surgery, the relationship is modest, and there appears to be a testing threshold beyond which additional tests do not result in additional surgeries. For percutaneous coronary intervention, the relationship is very tight, and no threshold appears to exist. Given the results of recent studies of medical versus invasive management of stable coronary disease, patients living in high-diagnostic-intensity regions may be getting more treatment than they want or need.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.