Appropriateness of coronary artery bypass graft surgery performed in northern New England

J Am Coll Cardiol. 2008 Jun 17;51(24):2323-8. doi: 10.1016/j.jacc.2008.01.067.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • American Heart Association
  • Angioplasty, Balloon, Coronary / statistics & numerical data
  • Coronary Artery Bypass / statistics & numerical data*
  • Coronary Artery Disease / surgery
  • Coronary Artery Disease / therapy
  • Female
  • Geography
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand / statistics & numerical data*
  • Humans
  • Male
  • New England
  • Practice Guidelines as Topic
  • Registries
  • Stroke Volume
  • United States