This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O'Connor, G. T. Search for Related Content PubMed Articles by O'Connor, G. T. Related Collections Related Article

CLINICAL RESEARCH: CORONARY ARTERY SURGERY

Appropriateness of Coronary Artery Bypass Graft Surgery Performed in Northern New England

Gerald T. O'Connor, PhD, ScD^_*,_*, Elaine M. Olmstead, BA, William C. Nugent, MD, Bruce J. Leavitt, MD^||, Robert A. Clough, MD^¶, Paul W. Weldner, MD^#, David C. Charlesworth, MD, Kristine Chaisson, RN, BSN, MS, Donato Sisto, MD, Edward R. Nowicki, MD, MS^_**, Richard P. Cochran, MD^||||, David J. Malenka, MD for the Northern New England Cardiovascular Disease Study Group

^_* Department of Medicine and of Community and Family Medicine, and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
^|| Department of Surgery, Fletcher Allen Health Care, Burlington, Vermont
^¶ Department of Surgery, Eastern Maine Medical Center, Bangor, Maine
^# Department of Surgery, Maine Medical Center, Portland, Maine
^_** Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
Department of Surgery, Catholic Medical Center, Manchester, New Hampshire
Department of Surgery, Concord Hospital, Concord, New Hampshire
Department of Surgery, Portsmouth Regional Medical Center, Portsmouth, New Hampshire
^|||| Department of Cardiothoracic Surgery, Central Maine Medical Center, Lewiston, Maine.

Manuscript received November 2, 2007; revised manuscript received January 11, 2008, accepted January 21, 2008.

^_* Reprint requests and correspondence: Dr. Gerald T. O'Connor, Clinical Research, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Rubin Building, Room 510, Lebanon, New Hampshire 03756. (Email: gerald.t.oconnor{at}dartmouth.edu).

Objectives: The goal of this study was to assess the concordance between the American College of Cardiology (ACC) and the American Heart Association (AHA) 2004 Guideline Update for Coronary Artery Bypass Graft Surgery and actual clinical practice.

Background: There is substantial geographic variability in the population-based rates of coronary artery bypass graft (CABG) procedures, and in recent years, there have been several public concerns about unnecessary cardiac care. The actual rate of inappropriate cardiac procedures is unknown.

Methods: We evaluated 4,684 consecutive isolated coronary artery bypass graft procedures performed in 2004 and 2005 in northern New England. Our regional registry data were used to categorize patients into clinical subgroups. Detailed clinical criteria were then used to categorize procedures within these subgroups as class I (useful and effective), class IIa (evidence favors usefulness), class IIb (evidence less well established), and class III (not useful or effective).

Results: Among these 4,684 procedures, we were able to classify 99.6% (n = 4,665). The majority of procedures were class I (87.7%). Class II procedures totaled 10.9%. The remaining 1.4% of procedures were class III.

Conclusions: In this regional study, we found that 98.6% of CABG procedures that could be classified were considered to be appropriate. In these data, actual clinical practice closely follows the recommendations of the 2004 ACC/AHA guidelines for CABG surgery.

Abbreviations and Acronyms   ACC = American College of Cardiology   AHA = American Heart Association   CABG = coronary artery bypass graft   PTCA = percutaneous transluminal coronary angioplasty

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A23-A24. [Full Text] [PDF]

This article has been cited by other articles:

				G. W. Neuberg The Cost of End-of-Life Care: A New Efficiency Measure Falls Short of AHA/ACC Standards Circ Cardiovasc Qual Outcomes, March 1, 2009; 2(2): 127 - 133. [Full Text] [PDF]

				S. Keyhani, L. C Kleinman, M. Rothschild, J. M Bernstein, R. Anderson, and M. Chassin Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort BMJ, October 3, 2008; 337(oct03_1): a1607 - a1607. [Abstract] [Full Text] [PDF]