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Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR.

Publication ,  Journal Article
Bradley, SM; Chan, PS; Spertus, JA; Kennedy, KF; Douglas, PS; Patel, MR; Anderson, HV; Ting, HH; Rumsfeld, JS; Nallamothu, BK
Published in: Circ Cardiovasc Qual Outcomes
May 2012

BACKGROUND: Measurement of hospital quality has traditionally focused on processes of care and postprocedure outcomes. Appropriateness measures for percutaneous coronary intervention (PCI) assess quality as it relates to patient selection and the decision to perform PCI. The association between patient selection for PCI and processes of care and postprocedural outcomes is unknown. METHODS AND RESULTS: We included 203 531 patients undergoing nonacute (elective) PCI from 779 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry between July 2009 and April 2011. We examined the association between a hospital's proportion of nonacute PCIs categorized as inappropriate by the 2009 Appropriate Use Criteria (AUC) for Coronary Revascularization and in-hospital mortality, bleeding complications, and use of optimal guideline-directed medical therapy at discharge (ie, aspirin, thienopyridines, and statins). When categorized as hospital tertiles, the range of inappropriate PCI was 0.0% to 8.1% in the lowest tertile, 8.1% to 15.2% in the middle tertile, and 15.2% to 58.6% in the highest tertile. Compared with lowest-tertile hospitals, mortality was not significantly different at middle-tertile (adjusted odds ratio [OR], 0.93; 95% confidence interval [CI], 0.73-1.19) or highest-tertile hospitals (OR, 1.12; 95% CI, 0.88-1.43; P=0.35 for differences between tertiles). Similarly, risk-adjusted bleeding did not vary significantly (middle-tertile OR, 1.13; 95% CI, 1.02-1.16; highest-tertile OR, 1.02; 95% CI, 0.91-1.16; P=0.07 for differences between tertiles) nor did use of optimal medical therapy at discharge (85.3% versus 85.7% versus 85.2%; P=0.58). CONCLUSIONS: In a national cohort of nonacute PCIs, a hospital's proportion of inappropriate PCIs was not associated with in-hospital mortality, bleeding, or medical therapy at discharge. This suggests PCI appropriateness measures aspects of hospital PCI quality that are independent of how well the procedure is performed. Therefore, PCI appropriateness and postprocedural outcomes are both important metrics to inform PCI quality.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 2012

Volume

5

Issue

3

Start / End Page

290 / 297

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Quality Indicators, Health Care
  • Patient Selection
  • Patient Discharge
  • Outcome and Process Assessment, Health Care
 

Citation

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Bradley, S. M., Chan, P. S., Spertus, J. A., Kennedy, K. F., Douglas, P. S., Patel, M. R., … Nallamothu, B. K. (2012). Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes, 5(3), 290–297. https://doi.org/10.1161/CIRCOUTCOMES.112.966044
Bradley, Steven M., Paul S. Chan, John A. Spertus, Kevin F. Kennedy, Pamela S. Douglas, Manesh R. Patel, H Vernon Anderson, Henry H. Ting, John S. Rumsfeld, and Brahmajee K. Nallamothu. “Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR.Circ Cardiovasc Qual Outcomes 5, no. 3 (May 2012): 290–97. https://doi.org/10.1161/CIRCOUTCOMES.112.966044.
Bradley SM, Chan PS, Spertus JA, Kennedy KF, Douglas PS, Patel MR, et al. Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes. 2012 May;5(3):290–7.
Bradley, Steven M., et al. “Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR.Circ Cardiovasc Qual Outcomes, vol. 5, no. 3, May 2012, pp. 290–97. Pubmed, doi:10.1161/CIRCOUTCOMES.112.966044.
Bradley SM, Chan PS, Spertus JA, Kennedy KF, Douglas PS, Patel MR, Anderson HV, Ting HH, Rumsfeld JS, Nallamothu BK. Hospital percutaneous coronary intervention appropriateness and in-hospital procedural outcomes: insights from the NCDR. Circ Cardiovasc Qual Outcomes. 2012 May;5(3):290–297.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 2012

Volume

5

Issue

3

Start / End Page

290 / 297

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Quality Indicators, Health Care
  • Patient Selection
  • Patient Discharge
  • Outcome and Process Assessment, Health Care