CONTEXT: Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. OBJECTIVE: To assess the appropriateness of PCI in the United States. DESIGN, SETTING, AND PATIENTS: Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. MAIN OUTCOME MEASURES: Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. RESULTS: Of 500,154 PCIs, 355,417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103,245 [20.6%]; non-ST-segment elevation myocardial infarction, 105,708 [21.1%]; high-risk unstable angina, 146,464 [29.3%]), and 144,737 (28.9%) for nonacute indications. For acute indications, 350,469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72,911 PCIs (50.4%) were classified as appropriate, 54,988 (38.0%) as uncertain, and 16,838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (≤1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10.8%; interquartile range, 6.0%-16.7%). CONCLUSIONS: In this large contemporary US cohort, nearly all acute PCIs were classified as appropriate. For nonacute indications, however, 12% were classified as inappropriate, with substantial variation across hospitals.
CONTEXT: Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. OBJECTIVE: To assess the appropriateness of PCI in the United States. DESIGN, SETTING, AND PATIENTS: Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. MAIN OUTCOME MEASURES: Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. RESULTS: Of 500,154 PCIs, 355,417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103,245 [20.6%]; non-ST-segment elevation myocardial infarction, 105,708 [21.1%]; high-risk unstable angina, 146,464 [29.3%]), and 144,737 (28.9%) for nonacute indications. For acute indications, 350,469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72,911 PCIs (50.4%) were classified as appropriate, 54,988 (38.0%) as uncertain, and 16,838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (≤1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10.8%; interquartile range, 6.0%-16.7%). CONCLUSIONS: In this large contemporary US cohort, nearly all acute PCIs were classified as appropriate. For nonacute indications, however, 12% were classified as inappropriate, with substantial variation across hospitals.
Authors: R G Brindis; S Fitzgerald; H V Anderson; R E Shaw; W S Weintraub; J F Williams Journal: J Am Coll Cardiol Date: 2001-06-15 Impact factor: 24.094
Authors: W S Weintraub; C R McKay; R N Riner; S G Ellis; P L Frommer; D B Carmichael; K E Hammermeister; M N Effros; J E Bost; D P Bodycombe Journal: J Am Coll Cardiol Date: 1997-02 Impact factor: 24.094
Authors: H Hemingway; A M Crook; J R Dawson; J Edelman; S Edmondson; G Feder; P Kopelman; E Leatham; P Magee; L Parsons; A D Timmis; A Wood Journal: J Public Health Med Date: 1999-12
Authors: Paul S Chan; Ralph G Brindis; David J Cohen; Philip G Jones; Elizabeth Gialde; Richard G Bach; Jeptha Curtis; Charles F Bethea; Marc E Shelton; John A Spertus Journal: J Am Coll Cardiol Date: 2011-04-05 Impact factor: 24.094
Authors: William B Borden; Rita F Redberg; Alvin I Mushlin; David Dai; Lisa A Kaltenbach; John A Spertus Journal: JAMA Date: 2011-05-11 Impact factor: 56.272
Authors: William E Boden; Robert A O'Rourke; Koon K Teo; Pamela M Hartigan; David J Maron; William J Kostuk; Merril Knudtson; Marcin Dada; Paul Casperson; Crystal L Harris; Bernard R Chaitman; Leslee Shaw; Gilbert Gosselin; Shah Nawaz; Lawrence M Title; Gerald Gau; Alvin S Blaustein; David C Booth; Eric R Bates; John A Spertus; Daniel S Berman; G B John Mancini; William S Weintraub Journal: N Engl J Med Date: 2007-03-26 Impact factor: 91.245
Authors: L H Hilborne; L L Leape; S J Bernstein; R E Park; M E Fiske; C J Kamberg; C P Roth; R H Brook Journal: JAMA Date: 1993-02-10 Impact factor: 56.272
Authors: Edward L Hannan; Zaza Samadashvili; Gary Walford; David R Holmes; Alice Jacobs; Samin Sharma; Stanley Katz; Spencer B King Journal: JACC Cardiovasc Interv Date: 2009-04 Impact factor: 11.195
Authors: Manesh R Patel; Gregory J Dehmer; John W Hirshfeld; Peter K Smith; John A Spertus Journal: J Am Coll Cardiol Date: 2009-02-10 Impact factor: 24.094
Authors: Peter Cram; John A House; John C Messenger; Robert N Piana; Phillip A Horwitz; John A Spertus Journal: Am Heart J Date: 2012-02 Impact factor: 4.749
Authors: Steven M Bradley; John A Spertus; Kevin F Kennedy; Brahmajee K Nallamothu; Paul S Chan; Manesh R Patel; Chris L Bryson; David J Malenka; John S Rumsfeld Journal: JAMA Intern Med Date: 2014-10 Impact factor: 21.873
Authors: Manesh R Patel; John H Calhoon; Gregory J Dehmer; James Aaron Grantham; Thomas M Maddox; David J Maron; Peter K Smith Journal: J Nucl Cardiol Date: 2017-04 Impact factor: 5.952
Authors: Paul N Fiorilli; Karl E Minges; Jeph Herrin; John C Messenger; Henry H Ting; Brahmajee K Nallamothu; Rebecca S Lipner; Brian J Hess; Eric S Holmboe; Joseph J Brennan; Jeptha P Curtis Journal: Circulation Date: 2015-09-18 Impact factor: 29.690