{"id":9154,"date":"2011-07-07T10:16:21","date_gmt":"2011-07-07T14:16:21","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=9154"},"modified":"2011-07-19T17:44:13","modified_gmt":"2011-07-19T21:44:13","slug":"ncdr-report-on-pci-appropriateness-a-slap-on-the-back%e2%80%a6or-a-slap-in-the-face","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/07\/07\/ncdr-report-on-pci-appropriateness-a-slap-on-the-back%e2%80%a6or-a-slap-in-the-face\/","title":{"rendered":"NCDR Report on PCI Appropriateness: A Slap on the Back\u2026or a Slap in the Face?"},"content":{"rendered":"<p>According to an <a title=\"JAMA PCI Appropriateness Study\" href=\"http:\/\/jama.ama-assn.org\/content\/306\/1\/53.short\">analysis of data from the National Cardiovascular Data Registry (NCDR), <\/a>nearly all\u00a0(98.6%) acute PCIs (i.e., those done for STEMI, NSTEMI, and unstable angina) were classified as appropriate. For nonacute indications, however, only 50% were classified as appropriate; 38% were of uncertain appropriateness, and 12% were deemed inappropriate.<\/p>\n<p><strong><em>Dig under the hood and what do you find?<\/em><\/strong><\/p>\n<p>1. Appropriateness could not be determined in 17% of the &gt; 600,000 PCIs in the NCDR because of inadequate data. \u00a0If these represented low-risk patients, then the rate of inappropriate PCIs in the nonacute setting\u00a0would be\u00a021%, not 12%.<\/p>\n<p>2. Substantial variation in the proportion of inappropriate PCIs in nonacute settings was noted among hospitals, ranging from 0% to 55%.<\/p>\n<p>3.\u00a0 Of the patients undergoing an inappropriate PCI in the nonacute setting, 99% were asymptomatic or only mildly symptomatic, 72% had low-risk ischemia on noninvasive stress testing, 94% did not have coronary anatomic findings that were\u00a0judged to be high risk, and 96% were treated with suboptimal antianginal therapy.<\/p>\n<p>4. Although the authors state that it is \u201cunlikely that hospitals inflated their rates of appropriate PCI by reporting more severe symptoms and stress test (results),\u201d <a href=\"http:\/\/cardiobrief.org\/2011\/05\/01\/pennsylvania-hopsital-at-center-of-controversy-had-very-high-stent-volume\/\">recent reports<\/a> suggest otherwise. \u00a0Physicians may exaggerate symptom and lesion severity in subjects undergoing unnecessary PCIs, whereas the hospital provides no oversight or turns a blind eye because of the reimbursement involved.<\/p>\n<p>4. \u00a0Of individuals who allegedly underwent <strong>appropriate<\/strong> nonacute PCI, 12% had no or minimal symptoms, 48% did not have high-risk features on noninvasive evaluation\u00a0 of ischemia, and 22% were on no antianginal medications (with another 39% on only one medication).\u00a0 <strong><em>How are these procedures appropriate?<\/em><\/strong><\/p>\n<p><strong><em>Is this report a slap on the back\u2026. or a slap in the face? <\/em><\/strong><em>Before answering, you may want to read <a title=\"Larry's Frank Discussion of PCI Appropriateness\" href=\"http:\/\/cardiobrief.org\/\">Larry Husten\u2019s take <\/a>on the ACC President\u2019s response.<\/em><\/p>\n<p><strong><em>Do you really believe that 98.6% of the PCIs performed for MI or unstable angina are truly appropriate?<\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>According to an analysis of data from the National Cardiovascular Data Registry (NCDR), nearly all\u00a0(98.6%) acute PCIs (i.e., those done for STEMI, NSTEMI, and unstable angina) were classified as appropriate. For nonacute indications, however, only 50% were classified as appropriate; 38% were of uncertain appropriateness, and 12% were deemed inappropriate. Dig under the hood and [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[301],"class_list":["post-9154","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/9154","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=9154"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/9154\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=9154"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=9154"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=9154"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}