Eine kritische Überprüfung der Indikationsstellung zur Koronarangiographie

A critical appraisal of the indication for coronary angiography Background: One of the quality control criteria applied to the indication for coronary angiography consists of the percentage of patients examined with “normal” coronary arteries. This has been suggested to be between 10 and 20%. Few published data exist about the population characteristics of patients undergoing invasive examination in the private health care setting. Material and methods: Prospective analysis of the data of all patients examined by the author during one year (n = 248). Referral patterns of patients with versus without significant coronary artery disease (CAD) are analysed, as well as patterns of pretest diagnosis. Results: 19% of patients evaluated by coronary angiography showed no relevant CAD or other structural (excluding hypertensive) heart disease. In the group in which no relevant CAD was found, patients were referred by the primary care physician in 17%, by an external cardiologist in 52%, by a primary care hospital in 2% and by the examining cardiologist in 29%. The corresponding figures for patients with first time diagnosis of relevant CAD are 28%, 37%, 12%, and 23%. Conclusion: In spite of potential conflict of interest, the percentage of patients undergoing invasive examination lies within the expected, published range. More data are needed concerning “acceptable” figures of patient selfreferral by the invasive cardiologist. Nonetheless, improving non-invasive diagnosis is a real need.