Validation of the Appropriate Use Criteria for Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease (from the COURAGE Trial)

Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Agg...

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Bibliographic Details
Published in:The American journal of cardiology 2015-07, Vol.116 (2), p.167-173
Main Authors: Bradley, Steven M., MD, MPH, Chan, Paul S., MD, MSc, Hartigan, Pamela M., PhD, Nallamothu, Brahmajee K., MD, MPH, Weintraub, William S., MD, Sedlis, Steven P., MD, Dada, Marcin, MD, Maron, David J., MD, Kostuk, William J., MD, Berman, Daniel S., MD, Teo, Koon K., MB BCh, PhD, Mancini, G.B. John, MD, Boden, William E., MD, Spertus, John A., MD, MPH
Format: Article
Language:English
Subjects:
Angina pectoris
Cardiology
Cardiovascular
Clinical outcomes
Coronary Angiography
Coronary Artery Disease - diagnosis
Coronary Artery Disease - surgery
Electrocardiography
Female
Heart attacks
Humans
Male
Middle Aged
Percutaneous Coronary Intervention - methods
Quality of Life
Reproducibility of Results
Retrospective Studies
Surveys and Questionnaires
Treatment Outcome
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Summary:Establishing the validity of appropriate use criteria (AUC) for percutaneous coronary intervention (PCI) in the setting of stable ischemic heart disease can support their adoption for quality improvement. We conducted a post hoc analysis of 2,287 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial patients with stable ischemic heart disease randomized to PCI with optimal medical therapy (OMT) or OMT alone. Within appropriateness categories, we compared rates of death, myocardial infarction, revascularization subsequent to initial therapy, and angina-specific health status as determined by the Seattle Angina Questionnaire in patients randomized to PCI + OMT to those randomized to OMT alone. A total of 1,987 patients (87.9%) were mapped to the 2012 publication of the AUC, with 1,334 (67.1%) classified as appropriate, 551 (27.7%) uncertain, and 102 (5.1%) as inappropriate. There were no significant differences between PCI and OMT alone in the rate of mortality and myocardial infarction by appropriateness classification. Rates of revascularization were significantly lower in patients initially receiving PCI + OMT who were classified as appropriate (hazard ratio 0.65; 95% confidence interval 0.53 to 0.80; p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2015.03.057