The New York Times this weekend featured a detailed article on the ongoing investigation into alleged inappropriate use of percutaneous coronary intervention (PCI) and substantial overutilization of stents at St. Joseph Medical Center, in Towson, MD. 

The issue of quality and appropriateness of medical care is not limited to use of stents in the state of Maryland (In fact, the Times article mentions similar cases in Texas and Louisiana), nor is it confined to the field of cardiology. That being said, this current issue provides an opportunity to illustrate how professionals societies, like the ACC, can take a leadership role in ensuring quality care through use of peer-review, accreditation and data management. 

We happen to have over two-thirds of the US angioplasty/stent clinical data in the United States. Applying the currently recognized best evidence for appropriate use to these procedures, our data shows that nearly 70 percent of stents are placed appropriately as life-saving care for persons having heart attacks. Of the 30 percent placed in patients electively, as in the NYT story, we believe about 12 percent may be inappropriate. That's 4 percent of overall stent use, which while not a crisis of mass overuse, is nonetheless unacceptable. The point is: we now have means to give doctors and hospitals continuous data feedback on how their performance compares with best evidence and with their peers. Why don't we use it!

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