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Eur J Cardiothorac Surg 2003;24:578-579
© 2003 Elsevier Science NL

Editorial comment

Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany

Received 20 February 2003; received in revised form 23 April 2003; accepted 17 July 2003.

The first 20% of the full text of this article appears below.

Appropriateness of invasive cardiovascular interventions in German hospitals (2000–2001): an evaluation
It is known that cardiovascular intervention rates vary widely among countries [1] and are not explained by geographical variations in the incidence of coronary artery disease. Among other explanations, two hypothesis are frequently put forward to answer this discrepancy: high rates of unnecessary procedures in those countries with a high per capita rate of interventions, and inappropriately high threshold in low frequency areas, rather than overuse elsewhere.

The latter view is supported by previous studies from North America [2] and a recent United Kingdom study suggested that under-use of revascularisation results in preventable morbidity and mortality [3].

Gandjour and collegues from Cologne in Germany have performed a study where the appropriateness of invasive cardiovascular interventions in Germany hospitals have been studied for the years 2000 and 2001 using the RAND/UCLA appropriateness criteria [4]. As the authors indicate in their article, the validity of the RAND/UCLA criteria to measure the appropriateness of coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA) and carotid endarteriectomy (CEA) has been demonstrated in a variety of studies. In addition, the RAND/UCLA test has been . . . [Full Text of this Article]