ABC | Volume 112, Nº5, May 2019

Original Article Analysis of the Appropriate Use Criteria for Coronary Angiography in Two Cardiology Services of Southern Brazil Luis Sérgio Carvalho Luciano, 1 R oberto Léo da Silva, 1, 2 Ozir Miguel Londero Filho, 1 Leandro Waldrich, 1 Luciano Panata, 1 Ana Paula Trombetta, 1 Julio Cesar Preve, 1 Tammuz Fattah, 1 Luiz Carlos Giuliano, 1 Luiz Eduardo Koenig São Thiago 1 Instituto de Cardiologia de Santa Catarina, 1 São José, SC – Brazil Hospital Universitário Prof. Dr. Polydoro Ernani São Thiago - Universidade Federal de Santa Catarina (UFSC), 2 Florianópolis, SC – Brazil Mailing Address: Luis Sérgio Carvalho Luciano • Rua Adolfo Donato da Silva, s/n - Praia Comprida - Secretaria do Serviço de Hemodinâmica do ICSC. Postal Code 88103-901, São José, SC – Brazil E-mail: luiscl@cardiol.br, luiscl@msn.com Manuscript received May 21, 2018, revised manuscript August 07, 2018, accepted October 02, 2018 DOI: 10.5935/abc.20190055 Abstract Background: Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization. Objective: To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil. Methods: This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05). Results: Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non‑performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment. Conclusion: We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests. (Arq Bras Cardiol. 2019; 112(5):526-531) Keywords: Coronary Angiography; Coronary Artery Disease/diagnostic imaging; Acute Coronary Syndrome; Percutaneous Coronary Intervention; Multicenter Study; Epidemiology. Introduction The management of coronary artery disease (CAD), the leading cause of mortality in the developed world, is based on the use of diagnostic and therapeutic procedures. Six decades after the first selective coronary angiography performed by Dr. Sones under improbable circumstances, 1 coronary angiography remains the gold standard for diagnosis of CAD, 2 although noninvasive methods have progressively gained some space. 3 Advances in medical technology were followed by rising costs, motivating research on cost-effectiveness issues. The identification of the exaggerated use of medical procedures has led to questions about when they will actually be needed. 4 In 2011 a significant drop in the rate of inappropriate angioplasties in the American state of New York was observed after the government announced that the payment would be connected to appropriation. That is, the financial question influenced the selection of patients for angioplasty. Analyzes of appropriate use should follow the progression of ways of financing. 5 In an effort to present criteria for rational use of cardiology services, the American College of Cardiology Foundation, and 11 other medical entities have issued the 2012 guideline for appropriate use of diagnostic cardiac catheterization. This recommendation has the potential to impact clinical decisions, the quality of health care, and health policies through the efficient use of resources. 6 In Brazil, this issue was previously studied with the 1999 guideline. An analysis of 145 coronary angiograms in patients with suspected stable ischemic disease was published in 2005. It was also observed that 34.5% of the indications were appropriate, and 65.5% uncertain, or inappropriate. 7 Also, based on the 1999 guideline, an Italian group studied the indications of 460 coronariographies, with no inappropriate angiography in its sample. 8 Based on the perspectives of the 2012 guideline, the indications of 526