Featured Research

from universities, journals, and other organizations

Most percutaneous coronary interventions (such as balloon angioplasty) performed in U.S. for acute indications appear to be warranted

Date:
July 5, 2011
Source:
JAMA and Archives Journals
Summary:
In an examination of the appropriateness of the widespread use of percutaneous coronary interventions (PCIs), researchers found that of more than 500,000 PCIs included in the study, nearly all for acute indications were classified as appropriate, whereas only about half of PCIs performed for nonacute indications could be classified as appropriate, according to a new study.

In an examination of the appropriateness of the widespread use of percutaneous coronary interventions (PCIs), researchers found that of more than 500,000 PCIs included in the study, nearly all for acute indications were classified as appropriate, whereas only about half of PCIs performed for nonacute indications could be classified as appropriate, according to a study in the July 6 issue of JAMA.

Related Articles


"Approximated 600,000 percutaneous coronary interventions [procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries] are performed in the United States each year, at a cost that exceeds $12 billion. 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. 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," according to background information in the article. Recently, appropriate use criteria for coronary revascularization were jointly developed by 6 professional organizations to support the rational and judicious use of PCI.

Paul S. Chan, M.D., M.Sc., of Saint Luke's Mid America Heart and Vascular Institute, Kansas City, Mo., and colleagues conducted a study to quantify the proportion of PCIs classified as appropriate, of uncertain appropriateness, and as inappropriate for acute as well as nonacute indications. The study included data from patients within the National Cardiovascular Data Registry undergoing PCI between July 2009 and September 2010 at 1,091 U.S. hospitals. The appropriateness of PCI was determined using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute indication (ST-segment elevation myocardial infarction -- a certain pattern on an electrocardiogram following a heart attack; non-ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication.

Of 500,154 procedures classified, 103,245 (20.6 percent) were for ST-segment elevation myocardial infarction, 105,708 (21.1 percent) for non-ST-segment elevation myocardial infarction, 146,464 (29.3 percent) for high-risk unstable angina, and 144,737 (28.9 percent) for nonacute elective indications. Based on the appropriate use criteria definition for acute procedures, 355,417 PCIs (71.1 percent) were for acute indications and 144,737 (28.9 percent) were for nonacute indications. Heart attack comprised 58.8 percent of all acute procedures, while high-risk unstable angina comprised 41.2 percent.

The researchers found that the vast majority (98.6 percent) of acute PCIs were classified as appropriate, with 0.3 percent classified as uncertain and 1.1 percent as inappropriate. Overall, 50.4 percent of nonacute PCIs were classified as appropriate, while 38.0 percent were for uncertain indications and 11.6 percent were for inappropriate indications. In general, compared with procedures classified as appropriate and uncertain, inappropriate PCIs were more likely to occur in patients with no angina, low-risk non-invasive stress testing results or suboptimal antianginal therapy.

There was substantial hospital-level variation in the proportion of inappropriate procedures for nonacute indications. Hospitals in the lowest quartile had rates of inappropriate PCI of 6 percent or lower, while the rate of inappropriate PCI was greater than 16 percent among hospitals in the highest quartile. Analysis of the data suggested an 80 percent greater likelihood of patients with identical clinical characteristics receiving an inappropriate PCI at one randomly selected hospital as compared with another.

"Collectively, these findings suggest an important opportunity to examine and improve the selection of patients undergoing PCI in the non-acute setting," the authors write.

"Better understanding of the clinical settings in which inappropriate PCIs occur and reduction in their variation across hospitals should be targets for quality improvement."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. P. S. Chan, M. R. Patel, L. W. Klein, R. J. Krone, G. J. Dehmer, K. Kennedy, B. K. Nallamothu, W. D. Weaver, F. A. Masoudi, J. S. Rumsfeld, R. G. Brindis, J. A. Spertus. Appropriateness of Percutaneous Coronary Intervention. JAMA: The Journal of the American Medical Association, 2011; 306 (1): 53 DOI: 10.1001/jama.2011.916

Cite This Page:

JAMA and Archives Journals. "Most percutaneous coronary interventions (such as balloon angioplasty) performed in U.S. for acute indications appear to be warranted." ScienceDaily. ScienceDaily, 5 July 2011. <www.sciencedaily.com/releases/2011/07/110705183618.htm>.
JAMA and Archives Journals. (2011, July 5). Most percutaneous coronary interventions (such as balloon angioplasty) performed in U.S. for acute indications appear to be warranted. ScienceDaily. Retrieved October 25, 2014 from www.sciencedaily.com/releases/2011/07/110705183618.htm
JAMA and Archives Journals. "Most percutaneous coronary interventions (such as balloon angioplasty) performed in U.S. for acute indications appear to be warranted." ScienceDaily. www.sciencedaily.com/releases/2011/07/110705183618.htm (accessed October 25, 2014).

Share This



More Health & Medicine News

Saturday, October 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Texas Nurse Nina Pham Cured of Ebola

Texas Nurse Nina Pham Cured of Ebola

AFP (Oct. 25, 2014) — An American nurse who contracted Ebola while caring for a Liberian patient in Texas has been declared free of the virus and will leave the hospital. Duration: 01:01 Video provided by AFP
Powered by NewsLook.com
Toxin-Packed Stem Cells Used To Kill Cancer

Toxin-Packed Stem Cells Used To Kill Cancer

Newsy (Oct. 25, 2014) — A Harvard University Research Team created genetically engineered stem cells that are able to kill cancer cells, while leaving other cells unharmed. Video provided by Newsy
Powered by NewsLook.com
IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) — IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) — A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins