Percutaneous coronary intervention (PCI) procedure rates are significantly lower among Medicare patients with acute myocardial infarction (AMI) who are treated in states that publicly report outcomes data as compared to states without public reporting programs, according to a study published on Oct. 9 in The Journal of the American Medical Association.

Specifically, high-risk patients including, non-ST-segment elevation myocardial infarction (NSTEMI), cardiogenic shock and cardiac arrest patient subgroups, had the most strikingly lower rates of PCI. Additionally, an examination of Massachusetts, the only state that initiated public PCI reporting in the last decade, revealed a significantly lower rate of PCI utilization rates compared to the prereporting  period. However, the study was not able to find an association between public reporting and lower overall 30-day mortality rates for patients with acute MI.

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While public reporting of outcomes data can help patients make informed choices about where to receive their care and enhance physician performance, there is concern that high-risk patients may be denied or transferred to states without public reporting of outcomes data. Previous research on this topic is limited to coronary artery bypass graft (CABG) surgery and the data is outdated. Since PCI has become an increasingly common treatment method for patients with ischemic heart disease, numerous states are exploring public reporting for the procedure. Currently, New York, Pennsylvania and Massachusetts are the only states with mandatory public reporting programs for PCI.

Given these circumstances, the authors approached three key questions:

1. "Are patients with an AMI less likely to receive a PCI in public reporting vs. nonreporting states?"
2. "Does this relationship vary with the risk profile of the patient?"
3. "Given that public reporting is meant to improve outcomes, is public reporting associated with lower mortality for patients with acute MI?"
4. The study looked at 97,802 Medicare patients with acute MI in three states with public reporting of PCI outcomes and seven regional control states without public reporting between 2002 and 2010.

Due to various potential explanations for the study's findings, the authors point out that "new approaches are needed to definitively understand whether outcomes were different in public reporting states." "Providing real-time models of both risk and benefit may help physicians, patients, and families make more informed decisions about when to pursue PCI," they continue. "Similarly, strategies to provide adequate credit for taking care of the sickest patients would also be useful."

In an editorial published alongside the study, Mauro Moscucci, MD, MBA, FACC, notes, "Patients are often treated regardless of the perceived futility of the planned intervention. The study by Joynt et. al. confirms the possible unintended consequences of public reporting, while highlighting its association with (or lack of association with) clinical outcomes. In addition, these findings may help spearhead a new focus on procedures that, while perceived appropriate based on current use criteria, might not result in added benefit in selected patients."

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