NCDR Study Finds Use of Rarely Appropriate PCI Procedures Have Declined Sharply
The number of percutaneous coronary intervention (PCI) procedures classified as "rarely appropriate" declined sharply between 2010 and 2014, as did the number of those performed on patients with non-acute conditions, according to results of a study presented Nov. 9 during AHA 2015 in Orlando, and simultaneously published in the Journal of the American Medical Association.
The study used data from ACC's CathPCI Registry, and looked at records from 2.7 million PCI procedures at 766 hospitals between July 2009 and December 2014. Results showed that the annual volume of PCI procedures for acute indications changed little over the study period, with 377,540 in 2010 compared to 374,543 in 2014. However, the volume of procedures for non-acute PCI declined significantly, from 89,704 in 2010 to 59,375 in 2014.
Further, investigators found that the proportion of "rarely appropriate" – previously classified as "inappropriate" – procedures performed for non-acute PCI declined by more than 50 percent, from 26.2 percent to 13.3 percent. The absolute number of "rarely appropriate" procedures decreased by 64 percent, from 21,781 to 7,921.
"Collectively, these findings suggest that the practice of interventional cardiology has evolved since the introduction of Appropriate Use Criteria in 2009," the authors conclude.
"It appears that we are doing a better job of selecting patients who are more likely to benefit from having a stent procedure," adds Nihar R. Desai, MD, MPH, the study's lead author. "At the same time, we're doing a better job of documenting the reasons why a stent procedure is indicated."
In a corresponding editorial comment, Robert A. Harrington, MD, FACC, says that the cardiology community has been receptive to using data, evidence and guidelines to inform their practice, and creating a nationally available quality registry system has been an important part of that development. However, he notes that moving forward, "More emphasis must be placed on achieving interoperability across health care systems."
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