Validity of criteria used for detecting underuse of coronary revascularization

摘要: Objective. —To assess criteria used for detecting underuse of coronary artery revascularization procedures in terms patient outcomes. Design. —Retrospective cohort study using medical records supplemented by a telephone survey and review county death records. Setting. —Four public hospitals two academically affiliated private Los Angeles County, California. Participants. —A total 671 patients who had angiography between June 1,1990, September 30,1991, met explicit clinical the necessity bypass graft (CABG) surgery or percutaneous transluminal angioplasty (PTCA). Main Outcome Measures. —For all (n=671), we estimated association receipt necessary mortality (median follow-up after angiography, 797 days) adjusting potential confounders. For completing interview (n=374), examined relationship frequency chest pain. Results. —Patients received within 1 year lower than those did not (8.7% vs 15.8%, P =.01), this persisted adjustment extent disease, symptom complex, ejection fraction, cardiac surgical risk index (adjusted odds ratio=0.49; 95% confidence interval, 0.28 to 0.86). The same general results were obtained whether was 30 days catheterization, panelists' ratings individual variables entered as covariates, statistical procedure logistic regression Cox proportional hazards analysis. In addition, among responding survey, receiving less pain at ( =.03). Conclusions. —Among meeting revascularization, treated medically. These support validity RAND/ UCLA these procedures, but more research is needed confirm findings determine guidelines other procedures. JAMA . 1995;274:632-638)