OBJECTIVES: Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. The objective is to assess the appropriateness of PCI in the United States.
METHODS: 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, nonâ€“ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication.
RESULTS: Of 500, 154 PCIs, 355 417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103, 245 [20.6%]; nonâ€“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, 1,055 (0.3%) as uncertain, and 3,893 (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 (â‰¤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