Indications for percutaneous coronary interventions performed in US hospitals: a report from the NCDR®

Abstract

Background There are many factors hypothesized as contributing to overuse of percutaneous coronary intervention (PCI) in the United States (U.S.), including financial ties between physicians and hospitals, but empirical data are lacking. We examined PCI indications in not-for-profit (NFP), major teaching, for-profit (FP) and physician-owned specialty hospitals. Methods A retrospective cohort study of 1,113,554 patients who underwent PCI in 694 hospitals (NFP=471, teaching=131, FP=79, specialty=13) participating in the National Cardiovascular Data Registry® (NCDR®) CathPCI Registry® between January 1, 2004 and December 31, 2007. PCI indications derived from American College of Cardiology (ACC) Guidelines were classified as: survival benefit (patients with primary reperfusion for STEMI); potential quality of life (QOL) benefit (patients with NSTEMI, ACS, positive stress test, or chest pain); or unclear indications (patients receiving PCI without an obvious potential survival or QOL benefit). Results The percentage of PCI performed for unclear indications was somewhat higher for specialty hospitals (5.1% of all procedures) as compared with other hospital categories (FP 4.7%, NFP 4.2%, teaching 4.5%; P<0.001). Overall, 17% of hospitals had 20% or more of their total PCI procedures performed for unclear indications but the proportion of FP, NFP, teaching, and specialty hospitals reaching this threshold was not statistically different (20%, 16%, 17% and 15% respectively; P=.84). Conclusions A small proportion of PCI procedures were performed in patients with unclear indications, but there was wide variation across hospitals. On average, specialty hospitals performed more PCIs for unclear indications. Efforts to reduce variability should be pursued.

A fitting machine learning prediction model for short-term mortality following percutaneous catheterization intervention: a nationwide population-based study

“…Coronary heart disease is a major public health concern, especially in developed countries (1). Consequently, percutaneous coronary intervention (PCI) is one of the most extensively and increasingly used procedures (2), and it is indicated as the primary treatment for ST-elevation myocardial infarction (STEMI) and also for non-STEMI, atypical chest pain, stable angina, unstable angina, and positive stress tests (3). With advances in technology, periprocedural complications of PCI have declined and patients often achieve favorable outcomes (4).…”

Coronary revascularization in patients with stable coronary disease and diabetes mellitus

“…Patients with diabetes mellitus comprise one-third of all performed percutaneous interventions. 31 Rates of incomplete revascularizations and complications from these procedures are much higher in patients with diabetes compared to the general population. 32 , 33 There are two main interventional approaches for the treatment of CAD and their outcomes have varied over the years, largely depending on varying clinical factors and technological advances ( Figure 2 ).…”

Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan

“… 15 , 16 , 17 Few studies have evaluated variations in the management of elective cases, comprising most PCIs that are currently performed, and are more amenable to implementation efforts promoting standardised recommendations from clinical practice guidelines. 18 , 19 , 20 …”