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Steven J. Bernstein, MD, MPH; Lee H. Hilborne, MD, MPH; Lucian L. Leape, MD; Mary E. Fiske, MD; Rolla Edward Park, PhD; Caren J. Kamberg, MSPH; Robert H. Brook, MD, ScD

JAMA. 1993;269(6):766-769.

Abstract
Objective.
—To determine the appropriateness of use of coronary angiography in New York State.

Design.
—Retrospective randomized medical record review.

Setting.
—Fifteen randomly selected hospitals in New York State that provide coronary angiography.

Patients.
—Random sample of 1335 patients undergoing coronary angiography in New York State in 1990.

Main Outcome Measures.
—Percentage of patients who underwent coronary angiography for appropriate, uncertain, or inappropriate indications.

Results.
—Approximately 76% of coronary angiographies were rated appropriate; 20%, uncertain; and 4%, inappropriate. Inappropriate use did not vary significantly between the elderly (ie, patients aged 65 years and older) and nonelderly, 4.7% and 3.9%, respectively. Although the rate of inappropriate use varied from 0% to 9% among hospitals, the difference was not significant. Rates of appropriateness did not vary by hospital location (upstate vs downstate), volume (fewer than 750 procedures annually or at least 750 procedures annually), teaching status, or whether revascularization was available at the hospital where angiography was performed.

Conclusions.
—Although coronary angiography was used for few inappropriate indications in New York State, many procedures were performed for uncertain indications in which the benefit and risk were approximately equal or unknown.

(JAMA. 1993;269:766-769)

Author Affiliations
From RAND, Santa Monica, Calif (Drs Bernstein, Hilborne, Leape, Fiske, Park, and Brook, and Ms Kamberg); the Schools of Medicine and Public Health, University of Michigan, Ann Arbor (Dr Bernstein); the Departments of Medicine (Drs Hilborne and Brook) and Pathology and Laboratory Medicine (Dr Hilborne), the School of Medicine (Drs Hilborne and Brook) and the School of Public Health (Dr Brook), UCLA, Los Angeles, Calif; and Harvard School of Public Health, Boston, Mass (Dr Leape).

Footnotes
Reprint requests to RAND, 1700 Main St, Santa Monica, CA 90406-2398 (Dr Bernstein).

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