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Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease



The American College of Cardiology Foundation (ACCF) with other professional societies developed appropriate use criteria (AUC) for diagnostic coronary angiography. This study aims to examine the appropriate use of elective coronary angiography for patients with suspected stable coronary artery disease in an Irish tertiary referral center.


A retrospective chart review of all elective outpatient diagnostic coronary angiograms performed in Cork University Hospital in 2014 was carried out. Data on demographics, risk factors, clinical presentation, and prior non-invasive investigations were extracted. Each patient was evaluated according to the 2012 ACCF appropriate use criteria and classified as appropriate, uncertain, or inappropriate. Univariable and multivariable logistic regression analysis was performed to investigate the factors that predict patients undergoing appropriate diagnostic coronary angiography.


Of 417 elective outpatient diagnostic coronary angiograms, 259 (62%) were included in the analysis. Of these, 108 (42%) were classified as appropriate, 97 (37%) as uncertain, and 54 (21%) as inappropriate. In multivariable analysis, those with private health insurance were more likely to have an appropriate indication for coronary angiogram (OR 2.1, 95% CI 1.2–3.7) as were those with atrial fibrillation (OR 3.9, 95% CI 1.2–12.8). Ever smokers were less likely to have an appropriate indication for coronary angiogram than never smokers (OR 0.5, 95% CI 0.3–0.9).


This is the first Irish study to evaluate the appropriate use of elective coronary angiography. Rates were similar to those of studies in other jurisdictions; however, there remains significant potential for quality improvement.

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The authors wish to acknowledge and thank the cardiologists and staff of the Cardiology Department in Cork University Hospital for their support of this work.

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Correspondence to Anne Marie O’Flynn.

Ethics declarations

This study was approved by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (CREC) and by the Quality and Risk Management Department of CUH.

Conflicts of interest

Dr. O’Flynn reports conference attendance and subsistence support from Pfizer pharmaceutical company and speaking honoraria from Menarini and Daiichi Sankyo pharmaceutical companies.

No other conflicts of interest are reported.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This was a retrospective audit and for this type of study formal consent is not required.

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Hanrahan, M.T., O’Flynn, A.M., McHugh, S.M. et al. Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease. Ir J Med Sci 188, 807–813 (2019).

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  • Appropriate use criteria
  • Cardiac catheterization
  • Coronary angiography
  • Quality of health care