Prognostic implications of percutaneous coronary interventions performed according to the appropriate use criteria for coronary revascularization

Objectives: To assess the prognostic implication of the ACCF/AHA/SCAI appropriate use criteria (AUC) for coronary revascularization in a cohort of non-acute coronary syndrome patients. Background: The AUC for coronary revascularization were developed in order to deliver high-quality care; however, the prognostic impact of these criteria remains undefined. Methods: Consecutive patients (n = 3817) undergoing elective percutaneous coronary intervention (PCI) at MedStar Washington Hospital Center since the 2009 AUC publication were retrospectively grouped according to AUC as an "Appropriate," "Inappropriate," or "Undetermined" indication for PCI. Outcomes to 1. year were compared. Results: PCI was categorized as "Appropriate" in 47%, "Inappropriate" in 1.8% and as "Uncertain" in 51% of patients. "Appropriate" PCI patients had a higher prevalence of hypertension and diabetes but a lower prevalence of smoking. "Inappropriate" PCI involved the treatment of more complicated lesions, with lower rates of drug-eluting stent utilization. While there were no differences in procedural complications among the 3 groups, in-hospital major complications and outcomes were worse for "Inappropriate" PCI patients. The 30-day (3.2% vs. 7% vs. 4.1%, p = 0.32) and 1-year (13.1% vs. 11.8% vs. 15.3%, p = 0.43) major adverse cardiac event rates of the "Appropriate," "Inappropriate," and "Uncertain" PCI patients, respectively, were comparable. In multivariable analysis, the procedural appropriateness was not associated with either in-hospital or 1-year outcome. Conclusions: At large, physicians practicing in tertiary centers adhere to the AUC when subjecting patients with non-acute coronary syndrome to revascularization. The present analysis did not demonstrate association between long-term outcome and procedure appropriateness according to the AUC.