{"id":15927,"date":"2012-02-08T16:58:52","date_gmt":"2012-02-08T21:58:52","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=15927"},"modified":"2012-02-08T16:58:52","modified_gmt":"2012-02-08T21:58:52","slug":"inappropriate-pci-an-inappropriate-critique","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/02\/08\/inappropriate-pci-an-inappropriate-critique\/","title":{"rendered":"(In)Appropriate PCI: An (In)Appropriate Critique?"},"content":{"rendered":"

According to a recently published study by Chan\u00a0and colleagues<\/a>, only 50% of the PCIs performed for nonacute indications were\u00a0classified as\u00a0appropriate, according to appropriate use criteria (AUC); 38% were \u201cuncertain,\u201d and 12% were inappropriate.<\/p>\n

In a new expedited publication, Marso\u00a0and colleagues \u00a0retort<\/a> by expressing concerns with the \u201ccurrent\u201d PCI AUC (see also our CardioExchange news coverage here). \u00a0However, the AUC document they critique is the 2009 version <\/a>and not<\/em> the current 2012 updated version<\/a>, which addresses many of their concerns, including:<\/p>\n

    \n
  1. Acknowledging when PCI may be appropriate even without an improvement in symptoms;<\/li>\n
  2. Incorporating fractional flow reserve (FFR) for identification of the culprit lesion; and<\/li>\n
  3. Including bypass graft status in patients with previous CABG.<\/li>\n<\/ol>\n

    Nonetheless, some of the issues they raised were not addressed in the update, including:<\/p>\n

      \n
    1. Lack of concordance between the AUC technical panel and the clinical cardiology community regarding PCI appropriateness designations;<\/li>\n
    2. Overdependence on stress testing pre-PCI; and<\/li>\n
    3. Reliability of the National Cardiovascular Data Registry (NCDR) for obtaining necessary data with which to assess PCI appropriateness.<\/li>\n<\/ol>\n

      Two recommendations of Marso\u00a0and colleagues\u00a0are quite controversial and deserve vetting, and we\u2019d like to hear your opinion<\/em><\/strong>.\u00a0 The authors\u00a0recommend that:<\/p>\n

        \n
      1. PCI classification should be changed from inappropriate to uncertain in patients with Canadian Cardiovascular Society class I or II angina while taking 0 or 1 antianginal medication who have 1- or 2-vessel CAD without involvement of the proximal LAD and low-risk findings on noninvasive testing; <\/em>and<\/li>\n
      2. <\/em>Preprocedural stress testing\u00a0should\u00a0not be required in patients with class II angina.<\/strong><\/em><\/li>\n<\/ol>\n

        Do you agree?<\/strong><\/p>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

        According to a recently published study by Chan\u00a0and colleagues, only 50% of the PCIs performed for nonacute indications were\u00a0classified as\u00a0appropriate, according to appropriate use criteria (AUC); 38% were \u201cuncertain,\u201d and 12% were inappropriate. In a new expedited publication, Marso\u00a0and colleagues \u00a0retort by expressing concerns with the \u201ccurrent\u201d PCI AUC (see also our CardioExchange news coverage […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[1134,231,1006,301],"class_list":["post-15927","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-appropriate-use-criteria","tag-cabg","tag-cathpci-registry","tag-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15927","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=15927"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/15927\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=15927"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=15927"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=15927"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}