The Appropriateness of Performing Coronary Angiography in Two Major Teaching Hospitals in Israel

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Abstract
Objective: To assess the appropriateness of using coronary angiography in two major medical centers in Israel. Methods: (a) Development of dichotomous appropriateness rating by concensus of an expert panel for possible indications to use coronary angiography; (b) applying the panel's rating to clinical data gathered from interviews and records of 499 patients who underwent coronary angiography. Results: Angiographies were performed inappropriately in 58% of patients: in 56% neither prognostic stratification was performed, nor was comprehensive medical therapy prior to angiography undertaken. Referral to catheterization from an acute care hospital, compared to ambulatory referral, correlated independently with an inappropriate angiogram. Conclusion: In the Israeli public health system there is still a high rate of inappropriate coronary angiography, most of the cases being due to error in management before performing angiographies.

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