Perspective:

Appropriate utilization of percutaneous coronary intervention (PCI) is an important national health care policy priority for the United States. Because PCI is both common and costly, critical appraisal of appropriateness is warranted. The appropriate use criteria (AUC) have broad implications for both health care providers and patients, and will likely be used as the basis for indications, treatment options, physician education, shared decision making, and reimbursement for years to come. Given some current limitations, future AUC should increase the number of clinical scenarios to decrease the unmappable rate, re-evaluate the need to always require a stress test in patients with symptomatic coronary artery disease, and adopt an intelligent, data-driven strategy to incorporate fractional flow reserve for culprit lesion identification. Finally, interventionalists should identify additional methods to assess appropriateness and engage in this national discussion to enhance the applicability, credibility, and sustainability of future AUC research. While deliberate inappropriate use of a procedure should not be condoned, the methodology for developing these criteria may need to be refined.