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

Published In: Heart, v. 77, no. 3, Mar. 1997, p. 219-224

Posted on RAND.org on January 01, 1997

by Annejet P. Meijler, Henk Rigter, Steven J. Bernstein, Jan K. Scholma, Joseph McDonnell, Arno Breeman, Jacqueline Kosecoff, Robert H. Brook

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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.

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