The Appropriateness of Intention to Treat Decisions for Invasive Therapy in Coronary Artery Disease in the Netherlands

Examines the appropriateness of intention-to-treat decisions concerning coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) for patients with coronary artery disease in the Netherlands. This is a perspective study of intention to treat and involves 10 referral heart centers and over 3,000 patients. Of coronary artery bypass surgery decisions, 84% were rated appropriate, 12% uncertain, and 4% inappropriate. The proportion of PTCA decisions was 39% appropriate, 31% uncertain, and 29% inappropriate. The main reason for inappropriateness of PTCA decisions was the presence of a Type C lesion in the artery to be dilated. If Type C lesions were downgraded, the rate of inappropriate PTCA decisions dropped to 6%. In conclusion, few CABG decisions in the Netherlands were inappropriate, and the main determinant for inappropriateness of PTCA decisions was its intended use in patients with type C lesions, who, at least in the past, were less likely to be successfully treated by this modality.