Authors' objectives:

The report consists of two parts: a literature review and panel ratings of appropriateness and necessity of Coronary Artery Bypass Graft (CABG) and Percutaneous Transluminal Coronary Angioplasty (PTCA). The results are used for auditing medical practice to determine the appropriateness and necessity of CABG and PTCA. During 1994, medical and quality of life information was prospectively collected on al patients referred for coronary angiography with suspected coronary artery disease in Sweden. The panel's ratings of appropriateness and necessity of these procedures will be used to determine to what extent there is an under use and over use of these procedures.

Authors' results and conclusions: The report includes (a) a review of the literature on the efficacy and risks of CABG and PTCA published from 1990 to March 1993, (b) a description of methods for rating a comprehensive set of indications for performing CABG and PTCA and, (c) a presentation of how a panel of Swedish experts rated the appropriateness and necessity of indications for CABG and PTCA. The panel judged 1,040 indications for PTCA and 1,098 indications for CABG, grouped in 8 chapters according to major medical problem. For each indication in each chapter, patients were divided into two categories: (a) a low to moderate surgical risk category, or (b) a high surgical category. Each of these two categories were rated three times, i.e. PTCA compared to medical therapy, CABG compared to medical therapy, and preference for PTCA or CABG.

Authors' recommendations: The chapters on chronic stable angina and on post myocardial infarction comprise the most common types of patients presenting for intervention, and it should be noted that a large number of possible indications were judged as uncertain. This may reflect the construction of the indication matrix, which may have been more detailed than the panellists were used to. Partly it reflects real uncertainty in a situation which requires the interventionist to exactly describe what information is needed for a decision to intervene or not. Other output or dissemination activity: The discussion within professional groups stimulated by this report will certainly influence the way patients are cared for. The planned continuation of the SBU project is also important in this respect.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1994

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care