The appropriate use criteria: Improvements for its integration into real world clinical practice
Corresponding Author
Lloyd W Klein MD
Cardiology Section, University of California, San Francisco, California, USA
Correspondence
Lloyd W Klein, Cardiology Section, UCSF Medical Center Moffitt Hospital, 11th Floor 505 Parnassus Avenue, San Francisco, CA 94143, USA.
Email: [email protected]
Search for more papers by this authorJacqueline Tamis-Holland MD
Department of Cardiovascular Diseases, Mount Sinai St. Luke's Hospital, New York, New York, USA
Search for more papers by this authorAjay J Kirtane MD, SM
Columbia University Irving Medical Center/New York-Presbyterian Hospital, Cardiovascular Research Foundation, New York, New York, USA
Search for more papers by this authorH Vernon Anderson MD
Cardiology Division, University of Texas Health Science Center, Houston, Texas, USA
Search for more papers by this authorJoaquin Cigarroa MD
Cardiovascular Division, Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon, USA
Search for more papers by this authorPeter L Duffy MD
Reid Heart Center, First Health of the Carolinas, Pinehurst, North Carolina, USA
Search for more papers by this authorJames Blankenship MD, MACC
Geisinger Medical Center, Danville, Pennsylvania, USA
Search for more papers by this authorC. Michael Valentine MD, MACC
Stroobants Cardiovascular Group, Lynchburg, Virginia, USA
Search for more papers by this authorFrederick GP Welt MD
Division of Cardiology, University of Utah Health, Salt Lake City, Utah, USA
Search for more papers by this authorFor The AUC Workgroup of the ISLC Endorsed by the Interventional Section Leadership Council, American College of Cardiology
Search for more papers by this authorCorresponding Author
Lloyd W Klein MD
Cardiology Section, University of California, San Francisco, California, USA
Correspondence
Lloyd W Klein, Cardiology Section, UCSF Medical Center Moffitt Hospital, 11th Floor 505 Parnassus Avenue, San Francisco, CA 94143, USA.
Email: [email protected]
Search for more papers by this authorJacqueline Tamis-Holland MD
Department of Cardiovascular Diseases, Mount Sinai St. Luke's Hospital, New York, New York, USA
Search for more papers by this authorAjay J Kirtane MD, SM
Columbia University Irving Medical Center/New York-Presbyterian Hospital, Cardiovascular Research Foundation, New York, New York, USA
Search for more papers by this authorH Vernon Anderson MD
Cardiology Division, University of Texas Health Science Center, Houston, Texas, USA
Search for more papers by this authorJoaquin Cigarroa MD
Cardiovascular Division, Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon, USA
Search for more papers by this authorPeter L Duffy MD
Reid Heart Center, First Health of the Carolinas, Pinehurst, North Carolina, USA
Search for more papers by this authorJames Blankenship MD, MACC
Geisinger Medical Center, Danville, Pennsylvania, USA
Search for more papers by this authorC. Michael Valentine MD, MACC
Stroobants Cardiovascular Group, Lynchburg, Virginia, USA
Search for more papers by this authorFrederick GP Welt MD
Division of Cardiology, University of Utah Health, Salt Lake City, Utah, USA
Search for more papers by this authorFor The AUC Workgroup of the ISLC Endorsed by the Interventional Section Leadership Council, American College of Cardiology
Search for more papers by this authorThe views expressed in this paper by the American College of Cardiology Interventional Section and Leadership Council do not necessarily reflect the views of the American College of Cardiology
Abstract
The purpose of this position statement is to suggest ways in which future appropriate use criteria (AUC) for coronary revascularization might be restructured to: (1) incorporate improvement in quality of life and angina relief as primary goals of therapy, (2) integrate the findings of recent trials into quality appraisal, (3) employ the combined information of the coronary angiogram and invasive physiologic measurements together with the results of stress test imaging to assess risk, and (4) recognize the essential role that patient preference plays in making individualized therapeutic decisions. The AUC is a valuable tool within the quality assurance process; it is vital that interventionists ensure that percutaneous coronary intervention case selection is both evidence-based and patient oriented. Appropriate patient selection is an important quality indicator and adherence to evidence-based practice should be one metric in a portfolio of process and outcome indicators that measure quality.
CONFLICT OF INTEREST
All authors have reported they have no relationships relevant to this article to disclose.
REFERENCES
- 1Klein LW, Harjaj KJ, Resnic F, et al. Revision of the SCAI position statement on public reporting. Catheter Cardiovasc Interv. 2017; 89(2): 269-279.
- 2Patel MH, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease. J Am Coll Cardiol. 2017; 69: 2212-2241.
- 3Welt FGP, Klein LW, Tamis-Holland J, et al. Views of appropriate use criteria (AUC) for catheterization and percutaneous coronary revascularization by practicing interventional cardiologists: results of a survey of ACC interventional section members. Catheter Cardiovasc Interv. 2019; 93(5): 875-879.
- 4Klein LW, Anderson HV, Rao SV. Proposed framework for the optimal measurement of quality assessment in percutaneous coronary intervention. JAMA Cardiol. 2019; 4: 963-964. https://doi.org/10.1001/jamacardio.2019.3228.
- 5Marso SP, Teirstein PS, Kereiakes DJ, Moses J, Lasala J, Grantham JA. Percutaneous coronary intervention use in the United States: defining measures of appropriateness. JACC Cardiovasc Interv. 2012; 5(2): 229-235.
- 6Hendel RC, Lindsay BD, Allen JM, et al. Appropriate use criteria methodology: 2018 update. J Am Coll Cardiol. 2018; 71: 935-948.
- 7Anderson HV, Shaw RE, Brindis RG, et al. Relationship between procedure indications and outcomes of percutaneous coronary interventions by American College of Cardiology/American Heart Association task force guidelines. Circulation. 2005; 112: 2786-2791.
- 8Anderson HV, Shaw RE, Brindis RG, et al. Risk-adjusted mortality analysis of percutaneous coronary interventions by American College of Cardiology/American Heart Association guidelines recommendations. Am J Cardiol. 2007; 99: 189-196.
- 9Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease (COURAGE). N Engl J Med. 2007; 356: 1503-1516.
- 10Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden. Results from the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial nuclear substudy. Circulation. 2008; 117: 1283-1291.
- 11 Bari 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009; 360: 2503-2515.
- 12Klein LW, Anderson HV, Rao SV. Performance metrics to improve quality in contemporary PCI practice. JAMA Cardiol. 2020; 5: 859-860. https://doi.org/10.1001/jamacardio.2020.0904.
- 13Bradley SM, Chan PS, Hartigan PM, et al. Validation of the appropriate use criteria for percutaneous coronary intervention in patients with stable coronary artery disease (from the COURAGE trial). Am J Cardiol. 2015; 116: 167-173.
- 14Sharir T, Bacher-Sier C, Dhar S, et al. Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography. Am J Cardiol. 2000; 11: 1171-1175.
- 15Desai NR, Bradley SM, Parzynski CS, et al. Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention. JAMA. 2015; 314: 2045-2053.
- 16Bradley SMCP, Spertus JA, Kennedy KF, et al. Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes. 2012; 3: 290-297.
- 17Hannan EL, Samadashvili Z, Cozzens K, et al. Changes in percutaneous coronary interventions deemed "inappropriate" by appropriate use criteria. J Am Coll Cardiol. 2017; 69(10): 1234-1242.
- 18Saxon JT, Chan PS, Tran AT, et al. Comparison of patient-reported vs physician-estimated angina in patients undergoing elective and urgent percutaneous coronary intervention. JAMA Netw Open. 2020; 3(6):e207406. https://doi.org/10.1001/jamanetworkopen.2020.7406.
- 19Bradley SM, Bohn CM, Malenka DJ, et al. Temporal trends in percutaneous coronary intervention appropriateness: insights from the clinical outcomes assessment program. Circulation. 2015; 132: 20-26.
- 20Wadhera RK, Sukul D, Secemsky EA, et al. Temporal trends in unstable angina diagnosis codes for out-patient percutaneous coronary interventions. JAMA Intern Med. 2019; 179: 259-261.
- 21Dayoub EJ, Nathan AS, Khatana SAM, et al. Trends in coded indications for percutaneous coronary interventions in medicare and the veterans affairs after implementation of hospital-level reporting of appropriate use criteria. Circ Cardiovasc Qual Outcomes. 2021; 14:e006887.
- 22Klein LW, Colina I, McKay C. The “may be appropriate” PCI: ambiguities in the appropriate use classification. J Invasive Cardiol. 2016; 28(11): 456-458.
- 23Klein LW, Blankenship JC, Kolansky DM, et al. Position statement concerning coverage policies for percutaneous coronary interventions based on the appropriate use criteria. Catheter Cardiovasc Interv. 2016; 87(6): 1127-1129.
- 24Ko DT, Guo H, Wijeysundera HC, et al. Assessing the association of coronary revascularization and clinical outcomes for patients with stable coronary artery disease. J Am Coll Cardiol. 2012; 60: 1876-1884.
- 25Bradley SM, Chan PS, Spertus JA, et al. Hospital PCI appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes. 2012; 5: 290-297.
- 26Hussey PS, Wertheimer S, Mehotra A. The association between health care quality and cost: a systematic review. Annals Int Med. 2013; 158: 27-34.
- 27Weintraub WS, Spertus JA, Kolm P, et al. Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med. 2008; 359: 677-687.
- 28Al-Lamee R, Thompson D, Dehbi HM, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018; 391: 31-40.
- 29Maron DJ, Hochman JS, Reynolds HR, et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med. 2020; 382: 1395-1407.
- 30Moussa ID, Klein LW, Shah B, et al. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization. J Am Coll Cardiol. 2013; 62: 1563-1570.
