New NCDR Study Looks at Hospital PCI Appropriateness and In-Hospital Procedural Outcomes

Measuring percutaneous coronary intervention (PCI) quality has traditionally focused on processes of care and post-procedure outcomes like in-hospital mortality, bleeding and vascular complication rates, and prescribing of guideline-recommended medications. However, appropriate use of PCI is increasingly being incorporated into registries like the ACC's CathPCI Registry®, as well as quality improvement programs, to measure the quality of patient selection for PCI.

A recent study published in May in Circulation used patient data from 779 hospitals participating in the CathPCI Registry between July 2009 and April 2011 to provide an important look at whether these efforts are having an impact. Specifically, the study looked at the association between a hospital's proportion of nonacute PCIs categorized as inappropriate based on the ACC Foundation's Appropriate Use Criteria (AUC) for Coronary Revascularization and in-hospital mortality, bleeding complications, and use of optimal guideline-directed medical therapy at discharge (ie, aspirin, thienopyridines, and statins). Currently, all hospitals submitting data into the CathPCI Registry are included in the CathPCI Registry Outcomes Report that includes the AUC Metrics. Hospitals that participate in the CathPCI Registry do not have the option to opt out of any part of the report.

In analyzing the data, study authors found no relationship between a hospital's proportion of inappropriate PCIs for nonacute indications and traditional performance measures of processes of care and post-procedural outcomes. However, "the observed large hospital-level variation in the proportion of inappropriate PCIs suggests differences in the quality of patient selection that was unrelated to how well the procedure was performed and emphasizes the importance of both appropriateness and post-procedural outcomes to informing PCI quality," the authors note.

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Moving forward the authors suggest that hospitals may want to put systems in place that use decision-support tools and other interventions prior to a patient's arrival in the catheterization lab to improve patient selection for PCI.

"This important study analyzing appropriateness of revascularization in the setting of non-Acute PCI in the U.S. substantially extends our knowledge of quality assessment for our cardiac catheterization laboratories," said former ACc President Ralph Brindis, MD, MACC. "Our own ACC/AHA/SCAI PCI clinical practice guidelines state that: 'Quality assessment is a complex process that includes more than a mere tabulation of success and complication rates.' Our opportunities for self-regulation and to be better stewards of our limited health care resources extend beyond our PCI clinical outcomes but now must include judicious and appropriate use of the proven highly effective strategy of PCI revascularization in properly selected patients."

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