OR12-3
Appropriateness of Percutaneous Coronary Interventions in Two Academic Centers in the State of Maryland
Presenter
Seyed Hossein Aalaei-Andabili, MD, Johns Hopkins Hospital, Baltimore, MD
Seyed Hossein Aalaei-Andabili, MD1, Anuj Gupta2, John Texter1, Jeffrey A. Brinker, M.D.3 and Julie M. Miller, M.D.4, (1)Johns Hopkins Hospital, Baltimore, MD, (2)University of Maryland Medical Center, Baltimore, MD, (3)-, Pikesville, MD, (4)Johns Hopkins University, Baltimore, MD
Keywords: Cath Lab Administration, Coronary, Quality and Training and Professional Development
Background
Up to 10% of percutaneous coronary interventions (PCI) are reported as rarely appropriate in the United States. We investigated appropriateness of PCIs in two academic centers in the state of Maryland.
Methods
From Jan-2015 to Sept-2020, a minimum of 5% of individual interventionalists’ PCI procedures were randomly selected for blinded external review (outside the health system) from two different academic centers. Clinical records and cine images were forwarded to the coordinating center for de-identification and distribution to independent interventional cardiologists. Appropriateness of PCIs were evaluated by 3 different criteria: clinical, angiographic, and Appropriate Use Guideline criteria (AUC).
Results
A total of 576 patients undergoing PCI were randomly selected for review. Twenty-three (4.0%) patients were excluded because of having ST elevation myocardial infarction (exclusion criteria), and 553 (96.0%) patients were entered to the final analysis. Fifty-nine (10.7%) patients had pre-intervention severity assessment with fractional flow reserve/ instantaneous wave‐free ratio (n=41), intravascular ultrasound (n=15), or both (n=3). There was a strong correlation between operator and reviewers’ severity report of coronary artery disease (r=0.82, p<0.001); 366 (66.2%) patients had PCI procedures assessed as “appropriate” for all three criteria, 93 (16.8%) patients had appropriate PCI based on two criteria, and 60 (10.8%) patients with one criteria. There were 33 (6%) of cases that were not “appropriate” by any criteria. However, only one (0.2%) case “rarely appropriate” by all 3 criteria. Although statistically non-significant, we observed a trend in improvement of PCI appropriateness from 2015 to 2020.
Conclusions
The rate of “rarely appropriate” PCI is exceedingly low in centers with physician-lead formal external review process, despite low usage invasive assessment tools. Different assessment criteria for procedural appropriateness are discordant in over 1/3 of cases. We believe multiple criteria for assessing procedural appropriateness is needed. Importantly, implementing an external reviewing process improves patient selection and may be beneficial in improving care nationwide.