Temporal Trends in Percutaneous Coronary Intervention Appropriateness: Insights From the Clinical Outcomes Assessment Program

It is unknown whether the appropriate use of percutaneous coronary intervention (PCI) has improved over time and whether trends in PCI appropriateness have been accompanied by changes in the use of PCI. We applied appropriate use criteria to determine the appropriateness of all 51 872 PCI performed...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2015-07, Vol.132 (1), p.20-26
Main Authors: Bradley, Steven M, Bohn, Chad M, Malenka, David J, Graham, Michelle M, Bryson, Chris L, McCabe, James M, Curtis, Jeptha P, Lambert-Kerzner, Anne, Maynard, Charles
Format: Article
Language:English
Subjects:
Aged
Female
Hospitals - trends
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - standards
Outcome and Process Assessment (Health Care) - trends
Patient Selection
Percutaneous Coronary Intervention - standards
Percutaneous Coronary Intervention - trends
Registries
Time Factors
Washington - epidemiology
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Summary:It is unknown whether the appropriate use of percutaneous coronary intervention (PCI) has improved over time and whether trends in PCI appropriateness have been accompanied by changes in the use of PCI. We applied appropriate use criteria to determine the appropriateness of all 51 872 PCI performed in Washington State from 2010 through 2013. We evaluated the number of PCIs performed from 2006 through 2013 to provide a comparator period that preceded statewide appropriateness assessment beginning in 2010. Between 2010 and 2013, the overall number of PCI decreased by 6.8% (13 267 PCIs in 2010 to 12 193 in 2013) with a 43% decline in the number of PCIs for elective indications (3818 PCIs in 2010 to 2193 PCIs in 2013). The decline in the use of elective PCI was significantly larger after the onset of statewide PCI appropriateness assessment in 2010 (P=0.03). The proportion of elective PCIs classified as appropriate increased from 26% in 2010 to 38% in 2013, whereas the proportion of inappropriate PCIs decreased from 16% to 13% (P
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.114.015156