This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.


No association was observed between elective percutaneous coronary intervention (PCI) appropriateness and 90-day outcomes among veterans treated at Veterans Affairs (VA) hospitals, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.

The data of patients included in the VA Clinical Assessment, Reporting, and Tracking Program were examined. All elective PCI procedures (N=2561) performed for the treatment of stable coronary artery disease between 2013 and 2015 at 59 facilities were included. The 2012 American College of Cardiology criteria was used to evaluate appropriateness of PCIs. Patients were assessed at 90 days for all-cause hospitalization and mortality. In this cohort, mean age was 66±8 years, 99% were men, and 86% were White.


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Of all procedures identified, 29.6% were determined to be appropriate. The remaining procedures were deemed “rarely appropriate” (10.4%) or “possibly appropriate” (60%).

Patients who received appropriate PCI procedures had a 14.9% hospital readmittance rate, which was lower than among patients with rarely appropriate (16.4%) or possibly appropriate (15.3%) procedures. The 90-day mortality rate was highest among patients who had appropriate (0.7%) PCIs compared with rarely appropriate (0.0%) or possibly appropriate (0.4%) procedures. The 90-day outcomes were not significantly different between patients who had appropriate and rarely appropriate PCIs (hazard ratio [HR], 0.85; 95% CI, 0.60-1.21; P =.37).

The facility-level covariance for the association between 90-day outcomes and rarely appropriate PCI was -0.025 (95% CI, -0.12 to 0.06), indicating that the treating facility did not significantly affect patient outcomes.

This study was limited by the imbalance of the patient population. As data was sourced from the VA, few women were included in this analysis. It remains unclear whether these results can be generalizable to women and more diverse patient populations.

“Including appropriateness in quality reporting initiatives may characterize PCI quality more fully,” noted the study authors.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Kini V, Hess P L, Liu W, et al. Association between elective percutaneous coronary intervention appropriateness and publicly reported outcomes. Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation MP120. doi:10.1161/CIRCOUTCOMES.120.007421

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