Indications for Percutaneous Coronary Interventions Performed in US Hospitals: A Report From the NCDR®

Study Questions:

What are the percutaneous coronary intervention (PCI) indications in not-for-profit (NFP), major teaching, for-profit (FP), and physician-owned specialty hospitals?

Methods:

This was a retrospective cohort study of 1,113,554 patients who underwent PCI in 694 hospitals (NFP 471, teaching 131, FP 79, specialty 13) participating in the CathPCI Registry® between January 1, 2004, and December 31, 2007. PCI indications derived from American College of Cardiology guidelines were classified as survival benefit (patients with primary reperfusion for ST-elevation myocardial infarction), potential quality-of-life benefit (patients with non–ST-elevation myocardial infarction, acute coronary syndrome [ACS], positive stress test, or chest pain), or unclear indications (patients receiving PCI without an obvious potential survival or quality-of-life benefit).

Results:

The percentage of PCIs performed for unclear indications was somewhat higher for specialty hospitals (5.1% of all procedures), as compared with other hospital categories (FP 4.7%, NFP 4.2%, major teaching 4.5%; p < 0.001). Overall, 17% of hospitals had ≥20% of their total PCI procedures performed for unclear indications, but the proportion of FP, NFP, major teaching, and specialty hospitals reaching this threshold was not statistically different (20%, 16%, 17%, and 15%, respectively; p = 0.84).

Conclusions:

The authors concluded that a small proportion of PCI procedures were performed in patients with unclear indications, but there was wide variation across hospitals.

Perspective:

This study reports that overall, a small proportion of PCI procedures (4%) were performed for patients with no clear indications for the procedure. Furthermore, there was only modest variation among the different hospital organizational structures, with specialty hospitals performing the greatest proportion of PCIs with unclear indications. However, there was marked variation among individual hospitals, with 17% of hospitals providing >1 in 5 of their PCIs in patients who would not obviously benefit from the procedure in terms of improved survival or quality of life. These findings call for a need for studies to better understand the reasons for these variations, which in turn may lead to more appropriate selection of patients for PCI.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS

Keywords: Registries, Myocardial Infarction, Acute Coronary Syndrome, Chest Pain, Quality of Life, Cardiology, Disclosure, United States, Percutaneous Coronary Intervention, Exercise Test


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