Variations in the use of coronary angiography in three cities in the Trent Region.

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Abstract
OBJECTIVE--To establish the characteristics of patients referred for coronary angiography and the outcome of investigation. DESIGN--Prospective study. SETTING--Three regional referral centres at Sheffield, Leicester, and Nottingham. PATIENTS--All patients referred for investigation from 1 July 1988 to 30 June 1989. INTERVENTIONS--Coronary angiography for suspected ischaemic heart disease. MAIN OUTCOME MEASURES--Site and extent of coronary artery disease at coronary angiography and subsequent intervention. RESULTS--There was a range of clinical activity with a trend towards symptomatic control in Nottingham where patients tended to have more severe angina of long duration and extensive drug treatment. Important coronary lesions were often found and most patients needed coronary artery bypass surgery or angioplasty. In Leicester and Sheffield, where angiography was used prognostically, patients tended to have mild angina of shorter duration and less extensive medical treatment; significant coronary disease was often found but fewer patients were recommended for further intervention. CONCLUSIONS--Referral for coronary angiography seems to reflect philosophical differences among the referring physicians. Referring patients late in the disease process ensures that most have a subsequent intervention but the benefits of revascularisation may be denied to those with mild symptoms but extensive coronary disease.