Three-year survival after percutaneous coronary intervention according to appropriateness criteria for revascularization

NY Methodist Hospital, Division of Cardiology, Brooklyn, NY 11215, USA.
The Journal of invasive cardiology (Impact Factor: 0.95). 11/2009; 21(11):554-7.
Source: PubMed


We sought to compare 3-year outcomes of percutaneous coronary intervention (PCI) according to recently published appropriateness criteria for PCI.
The choice of revascularization between PCI and coronary artery bypass grafting (CABG) remains uncertain in many patients despite numerous randomized clinical trials and meta-analyses.
Consecutive patients undergoing a first PCI at a single, large-volume institution were included if they did not have prior CABG and did not need emergency PCI. Patients were classified according to PCI indication into the following groups: Appropriate (A) - 1- or 2-vessel coronary artery disease (CAD), Uncertain (U) - 3-vessel CAD and Inappropriate (I) - left main coronary artery stenosis. Survival was assessed with the Social Security Death Index.
A total of 2,134 patients fulfilled the study criteria: 1,706 (80%) with "appropriate" PCI, 414 (19.4%) with "uncertain" PCI and only 14 (0.6%) with "inappropriate" PCI. In-hospital outcomes were very favorable, with 99.3%, 98.6% and 100% of the three groups, respectively, experiencing no complications (p = 0.31). The estimated survival in the three categories at 900 days was 92.6% (95% confidence interval 91-94%) for Group A, 91.3% (88-4%) for Group U and 66.9% (33-87%) for Group I; p = 0.014. The only predictors of mortality were advanced age and comorbidities, but not "appropriateness level" (p = 0.26).
The majority of PCIs performed would were classified as "appropriate." The patients classified as "uncertain" had similarly favorable outcomes, as those considered "appropriate" both during initial hospitalization and during the 3-year follow up. If confirmed, these data suggest that anatomically-based appropriateness criteria are not sufficient to inform choice of revascularization method.

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  • The Journal of invasive cardiology 11/2009; 21(11):558-62. · 0.95 Impact Factor
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    ABSTRACT: As one of several initiatives to transform health care delivery across the United States, the National Priorities Partnership has identified "eliminating overuse while ensuring the delivery of appropriate care" as a top priority. Cardiac revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), constitute one area of focus for reduction of overuse. Despite the multiyear development of clinical guidelines to define appropriate use of cardiac revascularization, substantial variability in the application of these procedures is observed. Concurrent data collection tools to support real-time clinical decision making regarding appropriateness are needed and can be used, along with financial incentives such as pay-for-performance programs and public reporting of performance information, to support more appropriate use of cardiac revascularization. Efforts to achieve more rational use of CABG and PCI should be made carefully and with the goal that patients receive the most appropriate and effective care.
    American Journal of Medical Quality 07/2011; 26(6):485-90. DOI:10.1177/1062860611407686 · 1.25 Impact Factor
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    ABSTRACT: Background Percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) should be performed in presence of objective evidence of myocardial ischemia. Our study investigated the appropriateness of PCI among ACS patients in Russia and explored clinical factors associated with PCI performance. Methods and results Clinical information about 65,912 ACS patients (60.5% male, aged 63.2±13.8 years) enrolled in the 2010–2011 Russian ACS Registry was examined. ACCF 2012 criteria were used to assess the appropriateness of PCI. PCI was performed in 13.8% of patients included in the study. Among patients with performed PCI (ACS-PCI patients), it was appropriate in 68.9%. In patients refused from PCI (ACS-nonPCI patients), it would be appropriate in 57.9% patients. Main clinical factors related to PCI were age, male sex, prior PCI, ST-segment elevation on ECG, and accordance with any of ACCF 2012 appropriate use criteria. But these factors were attributable for ACS-PCI patients only. It was a low correlation between these clinical factors and refuse from PCI. Conclusions It was shown that intervention was appropriate in the most patients with ACS received PCI. Among patients, refused from revascularization, PCI would be appropriate in more than half of them. We revealed that several clinical characteristics of ACS patients, including ACCF 2012 criteria, are fundamental for the decision to conduct PCI, but the negative decision was determined by other, non-clinical factors.
    Cor et vasa 09/2013; 56(1). DOI:10.1016/j.crvasa.2013.10.005
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