PCIs Done for Acute Indications Almost Always Appropriate

But a higher proportion of PCIs for nonacute indications are inappropriate or uncertain

WEDNESDAY, July 6 (HealthDay News) -- Most percutaneous coronary interventions (PCIs) performed for acute indications are appropriate, but for nonacute indications the proportion of inappropriate PCIs is higher, with substantial between-hospital variations, according to a study published in the July 6 issue of the Journal of the American Medical Association.

Paul S. Chan, M.D., from Saint Luke's Mid America Heart and Vascular Institute in Kansas City, Mo., and colleagues investigated the appropriateness of PCI according to the appropriate-use criteria for coronary revascularization. A total of 500,154 PCIs undertaken between July 2009 and September 2010 were analyzed, and were stratified according to indications into acute or nonacute. The proportion of PCIs classified as appropriate, uncertain, or inappropriate, and the extent of hospital variation in inappropriate PCIs were the outcomes measured.

The investigators found that 71.1 percent of the PCIs were for acute and 28.9 percent for nonacute indications. Of the PCIs for acute indications, 98.6 percent were classified as appropriate, 0.3 percent as uncertain, and 1.1 percent as inappropriate. Of the nonacute cases, 50.4 percent were identified as appropriate, 38.0 percent as uncertain, and 11.6 percent as inappropriate. The majority of the inappropriate PCIs for nonacute indications were carried out in patients with suboptimal antianginal therapy, low-risk ischemia on non-invasive stress testing, or no angina. The proportion of inappropriate PCIs for nonacute procedures showed a substantial hospital variation (median hospital rate, 10.8 percent; interquartile range, 6.0 to 16.7 percent), while that for acute indications showed minimal variation.

"In this large contemporary U.S. cohort, nearly all acute PCIs were classified as appropriate. For nonacute indications, however, 12 percent were classified as inappropriate, with substantial variation across hospitals," the authors write.

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