Frequency of appropriate, uncertain, and inappropriate coronary angiography by clinical presentation: indications are listed that describe > 75% of the patients within given presentation or appropriateness category
| Clinical presentation (n=3631) | Appropriate (n=2253) (62%) | Uncertain (n=1212) (33%) | Inappropriate (n=166) (5%) |
|---|---|---|---|
| Chronic stable angina class I/II | Positive exECG | No exECG | No or negative exECG and submaximal medication and age >75 years |
| 894 | 61% | 38% | 1% |
| Chronic stable angina class III/IV | Maximal medication or submaximal medication and positive exECG | Submaximal medication and no exECG | |
| 537 | 82% | 18% | 0% |
| Unstable angina (during admission) | After first 24 hours, pain persists or recurs | After first 24 hours, pain controlled by inpatient management | Within 24 hours of admission and pain controlled by inpatient management |
| 568 | 59% | 40% | 1% |
| Acute MI (during admission) | After 12 hours from symptom onset and MI complicated by persistent chest pain | After 12 hours from symptom onset and uncomplicated non-Q wave MI and did receive thrombolysis | After 12 hours from symptom onset and uncomplicated Q wave or non-Q wave MI and no or negative exECG |
| 216 | 78% | 13% | 9% |
| After acute MI (after discharge and < 12 weeks after acute MI) | Non Q wave MI, post-MI angina class III/IV or atypical chest pain with positive exECG, angina class I/II, and very positive exECG | Non Q wave MI, post-MI angina class I/II or no post-MI pain, no exECG, maximal medication | Q wave MI without heart failure, no exECG, submaximal medication, atypical chest pain |
| 167 | 34% | 64% | 2% |
| Post-revascularisation | Post-CABG or PTCA and angina class III/IV, without strong contraindications to CABG | Post-CABG or PTCA and angina class I/II, without strong contraindications to CABG | Post-CABG and angina class I/II and no exECG and on submaximal medication or asymptomatic. Post-PTCA, no or negative exECG and asymptomatic |
| 529 | 71% | 27% | 2% |
| Asymptomatic | Not high risk occupation, ⩾ 2 risk factors and very positive exECG or high risk occupation | Not high risk occupation, < 2 risk factors, positive exECG | Not high risk occupation, < 2 risk factors, negative or no exECG |
| 154 | 37% | 28% | 35% |
| Atypical chest pain | Positive exECG and > 1 risk factor | Positive exECG and ⩽ 1 risk factor | Negative or no exECG and no risk factors |
| 175 | 6% | 55% | 39% |
| Near sudden death | Angina class III/IV or angina class I/II and positive exECG | No exECG and asymptomatic | |
| 42 | 71% | 29% | 0% |
| Ventricular arrhythmia | ⩾ 2 episodes within previous year | ||
| 28 | 100% | 0% | 0% |
| Miscellaneous | Candidate for valve surgery, no angina, and age > 50 years | Candidate for valve surgery, age 35–50, ⩽ 2 risk factors, or unexplained cardiomegaly and congestive heart failure | Candidate for valve surgery, no angina, age < 35 years |
| 321 | 65% | 34% | 1% |
CABG, coronary artery bypass graft; exECG, exercise ECG; MI, myocardial infarction; PTCA, percutaneous transluminal coronary angioplasty. Angina class refers to the Canadian Cardiovascular Society classification