E1151 JACC April 5, 2011 Volume 57, Issue 14
QUALITY OF CARE AND OUTCOMES ASSESSMENT APPROPRIATENESS OF PERCUTANEOUS CORONARY INTERVENTION IN THE UNITED STATES: INSIGHTS FROM THE NCDR CATH/PCI REGISTRY ACC Oral Contributions Ernest N. Morial Convention Center, Room 238 Tuesday, April 05, 2011, 8:00 a.m.-8:15 a.m.
Session Title: Quality and Outcomes of Cardiovascular Care Abstract Category: 44. Quality of Care Presentation Number: 922-3 Authors: Paul Chan, Manesh Patel, Lloyd W. Klein, Ronald J. Krone, Gregory J. Dehmer, Kevin Kennedy, Brahmajee K. Nallamothu, W. Douglas Weaver, Frederick Masoudi, John Rumsfeld, John A. Spertus, Mid America Heart Institute, Kansas City, MO, University of Missouri, Kansas City, MO Background: Despite its widespread use, the appropriateness of percutaneous coronary interventions (PCI) in contemporary practice is unknown. Methods: Among 434,217 consecutive PCI procedures from 912 centers entered into the NCDR-Cath/PCI Registry from 7/2009 to 6/2010, we classified PCIs as appropriate, uncertain, or inappropriate, using the recently published Appropriate Use Criteria (AUC) for coronary revascularization. Analyses were stratified by acute (all MI and unstable angina with high-risk features) or non-acute indications for PCI. Procedures for non-acute indications without prior noninvasive testing (n = 46,361) or with incomplete data on noninvasive testing (n = 34,695) were excluded, as these data are required to classify the appropriateness of PCI. Moreover, hospital variation in rates of inappropriate PCI was examined. Results: Among the 353,161 PCIs which could be classified (81% of all PCIs), 300,695 (85%) were categorized as appropriate, 37,603 (11%) as uncertain, and 14,863 (4%) as inappropriate. For PCI in acute settings (n = 254,473), 99% of procedures were appropriate, while 0.3% were uncertain and 1% were inappropriate. In contrast, for non-acute PCI (n = 98,688), 51% were appropriate, 37% were uncertain and 12% were inappropriate. For non-acute indications, 66% of patients with inappropriate PCIs had minimal (CCS Class I) to no angina and 72% had noninvasive functional tests for ischemia which were reported as low-risk. Notably, there was substantial hospital variation in the proportion of inappropriate procedures for non-acute indications (median: 11%; interquartile range: 6% to 18%). Conclusions: In this large national registry, 4 in 5 PCI procedures could be classified according to the AUC. Among those classified, the majority were deemed appropriate, including almost all acute procedures. However, 1 in 9 non-acute procedures were classified as inappropriate according to the AUC. Better understanding of the clinical settings in which inappropriate PCI cases occur and reduction in their variation across hospitals may be targets for quality improvement.