Abstract 6223: The Appropriateness of PCI in a Regional Registry is High
Background. Evidence based medicine mandates constant examination of the appropriateness of care. The ACC/AHA/SCAI have published, and updated, PCI guidelines. We assessed the concordance between these guidelines and actual clinical practice in our region.
Methods. We evaluated 16,670 consecutive patients undergoing PCI in 2005–2006 at 10 hospitals contributing data to our regional PCI registry. As per the guidelines, we categorized patients into 5 groups (asymptomatic/CCS I-II angina, CCS III angina, UA/NSTEMI, STEMI, patients with prior CABG). Detailed clinical data, including number of diseased vessels and lesion location, myocardium at risk, the probability of angiographic success, and the probability of procedural risk, were then used to categorize procedures within subgroups as follows: Class I (useful and effective); Class IIa (evidence favors usefulness/efficacy); Class IIb (usefulness/efficacy less well established); Class III (not useful or effective).
Results. We were able to assign 16,350 patients (98.1%) to a clinical subgroup and within subgroups, to classify 98.9% of procedures. Class I procedures totaled 38.1%; Class IIa 56.0%; Class IIb 0.7%; Class III 4.1%; unclassifiable 1.1%. The class distribution varied by clinical group (Figure⇓). Of the 664 Class III procedures, 64.6% were asymptomatic/CCS I-II angina, 32.5% UA/NSTEMI, and 2.9% CCS III angina.
Conclusion. In this recent, regional experience we found that over 95% of PCI procedures were either Class I or Class II. In northern New England, actual clinical practice closely follows the ACC/AHA/SCAI recommendations for PCI appropriateness.