{"id":16149,"date":"2012-02-22T10:00:31","date_gmt":"2012-02-22T15:00:31","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=16149"},"modified":"2012-02-27T12:07:35","modified_gmt":"2012-02-27T17:07:35","slug":"part-5-clashing-views-of-appropriate-use-criteria-for-pci","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/02\/22\/part-5-clashing-views-of-appropriate-use-criteria-for-pci\/","title":{"rendered":"Part 5: Clashing Views of Appropriate Use Criteria for PCI"},"content":{"rendered":"<p><em>In\u00a0<a href=\"http:\/\/interventions.onlinejacc.org\/cgi\/content\/abstract\/j.jcin.2011.12.004v1\">a recent Viewpoint in JACC: Cardiovascular Interventions<\/a>,\u00a0Marso\u00a0and colleagues\u00a0expressed grave reservations about the application of appropriate use criteria for PCI in a\u00a0<a href=\"http:\/\/jama.ama-assn.org\/content\/306\/1\/53.long\">controversial study published last year in JAMA<\/a>\u00a0by Chan\u00a0and colleagues,\u00a0which found that only half of PCIs performed for nonacute indications were classified as appropriate. Interventional cardiology editors\u00a0<a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/interventional\/inappropriate-pci-an-inappropriate-critique\/\">Rick Lange and David Hillis asked CardioExchange members for their opinions<\/a>\u00a0on this topic. In this series of posts, Lange and Hillis question the main protagonists in the debate,<strong>\u00a0Steven Marso<\/strong>\u00a0and\u00a0<strong>Aaron Grantham<\/strong>, on the one side, and\u00a0<strong>Paul Chan<\/strong>\u00a0and\u00a0<strong>John Spertus<\/strong>\u00a0on the other side. All the authors are affiliated with the\u00a0Saint Luke\u2019s Mid America Heart Institute in Kansas City, Missouri.\u00a0<\/em><em>Click\u00a0for\u00a0<a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/expert-is-in\/part-1-clashing-views-of-appropriate-use-criteria-for-pci\/\">Part 1<\/a>,\u00a0<a title=\"Part 2: Clashing Views of Appropriate Use Criteria for PCI\" href=\"http:\/\/blogs.nejm.org\/cardioexchange\/expert-is-in\/part-2-clashing-views-of-appropriate-use-criteria-for-pci\/\">Part 2<\/a>,\u00a0<a title=\"Part 3: Clashing Views of Appropriate Use Criteria for PCI\" href=\"http:\/\/blogs.nejm.org\/cardioexchange\/expert-is-in\/part-3-clashing-views-of-appropriate-use-criteria-for-pci\/\">Part 3<\/a>, and <a title=\"Part 4: Clashing Views of Appropriate Use Criteria for PCI\" href=\"http:\/\/blogs.nejm.org\/cardioexchange\/expert-is-in\/part-4-clashing-views-of-appropriate-use-criteria-for-pci\/\">Part 4<\/a>\u00a0of this debate. This is the final installment of this series.<\/em><\/p>\n<p><strong>Lange &amp; Hillis:\u00a0<\/strong><strong>What is the acceptable threshold for inappropriate PCI for non-acute patients?<\/strong><\/p>\n<p><strong>Chan &amp; Spertus:\u00a0<\/strong>We do not currently have an absolute threshold that is \u2018acceptable\u2019. However, the variability across centers for non-acute PCIs, ranging from 0 to &gt;50%, is clearly unacceptable and suggests that some patients are being treated because of who their doctor is, rather than the severity of their disease and their potential to benefit from revascularization.<\/p>\n<p><strong>Marso &amp; Grantham:<\/strong>\u00a0In an ideal world, the inappropriate rate should approach 0%. However, given the complexities of measuring appropriateness, the writing committee rightly established the inappropriate rate at \u201cnational norms\u201d, which unfortunately remains elusive. Revealing the true norm will be a challenge and will require a rework of the AUC methodology.<\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-family: Arial, sans-serif;\"><br \/>\n<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In\u00a0a recent Viewpoint in JACC: Cardiovascular Interventions,\u00a0Marso\u00a0and colleagues\u00a0expressed grave reservations about the application of appropriate use criteria for PCI in a\u00a0controversial study published last year in JAMA\u00a0by Chan\u00a0and colleagues,\u00a0which found that only half of PCIs performed for nonacute indications were classified as appropriate. Interventional cardiology editors\u00a0Rick Lange and David Hillis asked CardioExchange members for their [&hellip;]<\/p>\n","protected":false},"author":121,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[1134,301],"class_list":["post-16149","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-appropriate-use-criteria","tag-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/16149","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\/121"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=16149"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/16149\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=16149"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=16149"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=16149"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}