Appropriateness of Percutaneous Coronary Intervention

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Abstract
Approximately 600 000 percutaneous coronary interventions (PCIs) are performed in the United States each year,1 at a cost that exceeds $12 billion.2 Patients who undergo PCI are exposed to risks of periprocedural complications and longer-term bleeding and stent thrombosis. Moreover, recent trials in stable patients without acute coronary syndromes have shown that PCI, compared with medical therapy, may provide only a modest population-average improvement in symptom relief.3 Given the cost and invasiveness of PCI, determining the extent to which PCI procedures are performed for appropriate and inappropriate indications could identify procedural overuse and areas for quality improvement and cost savings. However, a lack of national standards for defining appropriate PCI use has hampered previous efforts to identify opportunities for improved patient selection. Furthermore, the few existing studies4-6 were conducted before many of the current advances in PCI and more contemporary clinical trials on coronary revascularization.3