Geographic areas that perform the lowest number of percutaneous coronary intervention (PCI) procedures also perform appropriate procedures had a higher rate than those that perform a greater number of PCI, according to a study published in PLOS ONE. 

Furthermore, as the rates of appropriate PCI decrease, they increase for inappropriate and uncertain procedures, as well as for procedures not correlated to appropriate use criteria (AUC) established by the ACC, the American Heart Association, and the Society for Cardiovascular Angiography and Interventions.     

Using data from ACC’s CathPCI Registry linked with a limited dataset from Medicare, researchers assessed 2,010 records from 380,981 patients from 178 heath referral regions, or health care markets with at least one hospital performing major cardiovascular procedures and neurosurgery. These regions were divided into quintiles, with “1” representing the lowest utilization of PCI and “5” representing the highest.

Results showed that when stratified by clinical status, the rates for appropriate PCI to treat acute conditions were high across all quintiles (range between 95 percent and 96 percent). For non-acute conditions, the rate of appropriate PCI decreased from 27 percent in quintile 1 to about 22 percent in quintile 5, and the rate of inappropriate PCI increased from almost 12 percent to almost 13 percent. The rate of uncertain procedures also increased, from 20 percent to 23 percent. There was no difference in risk-adjusted mortality across quintiles. 

Perhaps the most telling difference was the increase of procedures not correlated to AUC – rising from about 39 percent in quintile 1 to 46 percent in quintile 5. Such procedures include those performed on patients with few symptoms of acute coronary syndrome who also did not have a stress test.

“This result indirectly suggests that a proportion of the uncorrelated PCIs are likely inappropriate,” says Michael P. Thomas, MD, FACC, the study’s lead author. To optimize PCI utilization, he notes that the study’s findings “support the need to explore the utility of routine application of AUC classification prior to elective PCI.” 

Keywords: Acute Coronary Syndrome, Angiography, Exercise Test, Health Care Sector, Hospitals, Medicare, Neurosurgery, Percutaneous Coronary Intervention, Referral and Consultation, Registries, Risk, National Cardiovascular Data Registries, CathPCI Registry

< Back to Listings