Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection, and Appropriateness of Percutaneous Coronary Intervention

• Published in: JAMA : the journal of the American Medical Association 2015-11, Vol.314 (19), p.2045-2053
• Main Authors: Desai, Nihar R, Bradley, Steven M, Parzynski, Craig S, Nallamothu, Brahmajee K, Chan, Paul S, Spertus, John A, Patel, Manesh R, Ader, Jeremy, Soufer, Aaron, Krumholz, Harlan M, Curtis, Jeptha P
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Angina Pectoris - classification; Angina Pectoris - drug therapy; Angina Pectoris - surgery; Angioplasty; Cardiovascular disease; Cross-Sectional Studies; Female; Humans; Male; Myocardial Revascularization - standards; Myocardial Revascularization - statistics & numerical data; Myocardial Revascularization - trends; Patient Selection; Percutaneous Coronary Intervention - classification; Percutaneous Coronary Intervention - standards; Percutaneous Coronary Intervention - statistics & numerical data; Percutaneous Coronary Intervention - trends; Severity of Illness Index
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2015.13764

IMPORTANCE: Appropriate Use Criteria for Coronary Revascularization were developed to critically evaluate and improve patient selection for percutaneous coronary intervention (PCI). National trends in the appropriateness of PCI have not been examined. OBJECTIVE: To examine trends in PCI utilization, patient selection, and procedural appropriateness following the introduction of Appropriate Use Criteria. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, longitudinal, cross-sectional analysis of patients undergoing PCI between July 1, 2009, and December 31, 2014, at hospitals continuously participating in the National Cardiovascular Data Registry CathPCI registry over the study period. MAIN OUTCOMES AND MEASURES: Proportion of nonacute PCIs classified as inappropriate at the patient and hospital level using the 2012 Appropriate Use Criteria for Coronary Revascularization. RESULTS: A total of 2.7 million PCI procedures from 766 hospitals were included. Annual PCI volume of acute indications was consistent over the study period (377 540 in 2010; 374 543 in 2014), but the volume of nonacute PCIs decreased from 89 704 in 2010 to 59 375 in 2014. Among patients undergoing nonacute PCI, there were significant increases in angina severity (Canadian Cardiovascular Society grade III/IV angina, 15.8% in 2010 and 38.4% in 2014), use of antianginal medications prior to PCI (at least 2 antianginal medications, 22.3% in 2010 and 35.1% in 2014), and high-risk findings on noninvasive testing (22.2% in 2010 and 33.2% in 2014) (P