Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines?
BACKGROUND:Non-invasive testing is recommended as a basis to decide about the indication for invasive coronary angiography (ICA) in patients with suspected stenotic coronary artery disease (CAD). However, a recent study based on insurance claims data reported that one third of patients undergoing IC...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2019-01-01
|
Series: | PLoS ONE |
Online Access: | https://doi.org/10.1371/journal.pone.0222137 |
id |
doaj-b54061f259a34e5b9c75b7527c1024af |
---|---|
record_format |
Article |
spelling |
doaj-b54061f259a34e5b9c75b7527c1024af2021-03-03T21:08:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01149e022213710.1371/journal.pone.0222137Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines?Rebecca SchieferHans RickliEvelyne NeurauterMarc BuserDaniel WeilenmannMicha T MaederBACKGROUND:Non-invasive testing is recommended as a basis to decide about the indication for invasive coronary angiography (ICA) in patients with suspected stenotic coronary artery disease (CAD). However, a recent study based on insurance claims data reported that one third of patients undergoing ICA in Switzerland did not have non-invasive testing beforehand. We aimed to re-evaluate the practice of testing prior to ICA in Switzerland by manual review of patient histories. METHODS:Retrospective analysis of all 816 consecutive patients (age 67±9 years, 70% males) undergoing elective ICA solely for the evaluation of stenotic CAD during the year 2015 in a single center in Eastern Switzerland. The proportion of patients undergoing a non-invasive test was assessed, and predictors of the lack of such a test were determined. RESULTS:764/816 (94%) patients had a non-invasive test prior to ICA. The majority of patients (728/816; 89%) had an exercise stress test, one fifth (160/816; 20%) underwent a test other than an exercise stress test (6% scintigraphy, 4% stress echocardiography, 6% stress magnetic resonance imaging, 4% computed tomography coronary angiography), and 122/816 (15%) patients had two tests. The use of antianginal drugs other than beta-blockers [odds ratio 1.92 (95% confidence interval 1.01-3.66); p = 0.047] and a lower left ventricular ejection fraction [odds ratio 0.97 (95% confidence interval 0.94-0.99) per one % point increase; p = 0.005] were independent predictors of the lack of a non-invasive test. ICA revealed stenotic CAD in 72% of patients, and 54% of patients underwent revascularization. Patients with and without non-invasive tests did not differ with respect to ICA findings and management. CONCLUSIONS:The present analysis suggests that patients are appropriately selected for ICA based on clinical judgement and non-invasive testing in Switzerland. There is no evidence for an overuse of ICA.https://doi.org/10.1371/journal.pone.0222137 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rebecca Schiefer Hans Rickli Evelyne Neurauter Marc Buser Daniel Weilenmann Micha T Maeder |
spellingShingle |
Rebecca Schiefer Hans Rickli Evelyne Neurauter Marc Buser Daniel Weilenmann Micha T Maeder Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines? PLoS ONE |
author_facet |
Rebecca Schiefer Hans Rickli Evelyne Neurauter Marc Buser Daniel Weilenmann Micha T Maeder |
author_sort |
Rebecca Schiefer |
title |
Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines? |
title_short |
Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines? |
title_full |
Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines? |
title_fullStr |
Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines? |
title_full_unstemmed |
Non-invasive assessment prior to invasive coronary angiography in routine clinical practice in Switzerland - Is it according to the guidelines? |
title_sort |
non-invasive assessment prior to invasive coronary angiography in routine clinical practice in switzerland - is it according to the guidelines? |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2019-01-01 |
description |
BACKGROUND:Non-invasive testing is recommended as a basis to decide about the indication for invasive coronary angiography (ICA) in patients with suspected stenotic coronary artery disease (CAD). However, a recent study based on insurance claims data reported that one third of patients undergoing ICA in Switzerland did not have non-invasive testing beforehand. We aimed to re-evaluate the practice of testing prior to ICA in Switzerland by manual review of patient histories. METHODS:Retrospective analysis of all 816 consecutive patients (age 67±9 years, 70% males) undergoing elective ICA solely for the evaluation of stenotic CAD during the year 2015 in a single center in Eastern Switzerland. The proportion of patients undergoing a non-invasive test was assessed, and predictors of the lack of such a test were determined. RESULTS:764/816 (94%) patients had a non-invasive test prior to ICA. The majority of patients (728/816; 89%) had an exercise stress test, one fifth (160/816; 20%) underwent a test other than an exercise stress test (6% scintigraphy, 4% stress echocardiography, 6% stress magnetic resonance imaging, 4% computed tomography coronary angiography), and 122/816 (15%) patients had two tests. The use of antianginal drugs other than beta-blockers [odds ratio 1.92 (95% confidence interval 1.01-3.66); p = 0.047] and a lower left ventricular ejection fraction [odds ratio 0.97 (95% confidence interval 0.94-0.99) per one % point increase; p = 0.005] were independent predictors of the lack of a non-invasive test. ICA revealed stenotic CAD in 72% of patients, and 54% of patients underwent revascularization. Patients with and without non-invasive tests did not differ with respect to ICA findings and management. CONCLUSIONS:The present analysis suggests that patients are appropriately selected for ICA based on clinical judgement and non-invasive testing in Switzerland. There is no evidence for an overuse of ICA. |
url |
https://doi.org/10.1371/journal.pone.0222137 |
work_keys_str_mv |
AT rebeccaschiefer noninvasiveassessmentpriortoinvasivecoronaryangiographyinroutineclinicalpracticeinswitzerlandisitaccordingtotheguidelines AT hansrickli noninvasiveassessmentpriortoinvasivecoronaryangiographyinroutineclinicalpracticeinswitzerlandisitaccordingtotheguidelines AT evelyneneurauter noninvasiveassessmentpriortoinvasivecoronaryangiographyinroutineclinicalpracticeinswitzerlandisitaccordingtotheguidelines AT marcbuser noninvasiveassessmentpriortoinvasivecoronaryangiographyinroutineclinicalpracticeinswitzerlandisitaccordingtotheguidelines AT danielweilenmann noninvasiveassessmentpriortoinvasivecoronaryangiographyinroutineclinicalpracticeinswitzerlandisitaccordingtotheguidelines AT michatmaeder noninvasiveassessmentpriortoinvasivecoronaryangiographyinroutineclinicalpracticeinswitzerlandisitaccordingtotheguidelines |
_version_ |
1714818594395652096 |