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Population rates of cardiac catheterization and yield of high-risk coronary artery disease

From the Departments of Medicine (Graham) and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta.; the Departments of Medicine (Ghali), Cardiovascular Sciences (Knudtson) and Community Health Sciences (Ghali, Faris, Galbraith), and the Centre for Health and Policy Studies (Ghali), University of Calgary, Calgary, Alta.; the Institute for Clinical Evaluative Sciences, and the Departments of Medicine and Public Health Sciences (Tu), University of Toronto, Toronto, Ont.; the Chinook Health Region (Zentner), Lethbridge, Alta.; and the Calgary office of the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) (Galbraith).
Merril Knudtson is the principal investigator of APPROACH.
APPROACH Clinical Steering Committee Edmonton: Stephen Archer, Michelle M. Graham, William Hui, Arvind Koshal, Colleen M. Norris and Ross T. Tsuyuki (chair); Calgary: Michael J. Curtis, P. Diane Galbraith, William A. Ghali, Merril L. Knudtson, Andrew Maitland, L. Brent Mitchell and Dean Traboulsi

Correspondence to: Dr. Michelle M. Graham, Division of Cardiology, University of Alberta Hospital, 8440–112 St., Edmonton AB T6G 2R7; fax 780 407-1496; mmgraham{at}cha.ab.ca

Background: The optimal population rate of cardiac catheterization is unknown. One potential way to determine it would be to examine whether there is a population rate beyond which the yield of high-risk coronary artery disease (CAD) does not rise.

Methods: Using a detailed clinical registry that captures all patients undergoing cardiac catheterization in Alberta, we determined annual population rates of cardiac catheterization and the corresponding yield of cases of high-risk CAD in each of Alberta's 17 health regions from 1995 to 2002. Least squares linear regression analysis and hierarchical modelling methods were then used to assess the linear relation between catheterization rates and rates of high-risk CAD.

Results: The age-adjusted average rate of cardiac catheterization among men ranged from 404.9 to 638.1 per 100 000 population aged over 20 years. Among women, the average rate ranged from 171.8 to 314.0 per 100 000. For both sexes, increased regional rates of catheterization were associated with a linearly increasing yield of high-risk CAD, with no evidence of a plateau in yield when more procedures were performed. One additional case of high-risk CAD was identified for every 2.5 additional cardiac catheterization procedures performed among men, and for every 3.7 additional procedures performed among women.

Interpretation: The increasing yield of patients with high-risk CAD associated with increased regional population rates of cardiac catheterization, together with the absence of a plateau in yield, suggests that Alberta's population rates of cardiac catheterization are suboptimal to detect people with high-risk CAD.

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