November 1, 2005Circulation54 citationsOpen Access
Relationship Between Procedure Indications and Outcomes of Percutaneous Coronary Interventions by American College of Cardiology/American Heart Association Task Force Guidelines
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Key Result
PCI performed for ACC/AHA Class I indications had higher clinical success (92.8%) compared to Class IIa (91.7%), Class IIb (89%), and Class III (85.5%) indications (P<0.001).
Study Design
Type
Observational (n=412,617)
Multicenter
Yes
Structured PICO
Does the ACC/AHA indication class for PCI correlate with in-hospital clinical success and adverse events in patients undergoing non-STEMI PCI?
P
Population
412,617 percutaneous coronary intervention (PCI) procedures from the ACC National Cardiovascular Data Registry (January 1, 2001, through March 31, 2004), excluding procedures performed for acute myocardial infarction (ST-segment elevation myocardial infarction).
I
Intervention
Percutaneous coronary intervention (PCI) categorized by ACC/AHA indication class (Class I, IIa, IIb, or III).
C
Comparator
Comparison across the different ACC/AHA indication classes (Class I vs. IIa vs. IIb vs. III).
O
Outcome
In-hospital clinical success, defined as angiographic success (<20% residual stenosis) at all lesions attempted without the adverse events of myocardial infarction, same-admission bypass surgery, or death.composite
Performing PCI for stronger, evidence-based ACC/AHA indications (Class I) is associated with significantly higher in-hospital clinical success and fewer adverse events compared to less established or inappropriate indications.
Main Result
p-value: p=<0.001
Abstract
BACKGROUND: An American College of Cardiology/American Heart Association (ACC/AHA) Task Force periodically revises and publishes guidelines with evidence-based recommendations for appropriate use of percutaneous coronary intervention (PCI). Some studies have suggested that closer adherence to guidelines can reduce variations in care, can improve quality, and may ultimately result in better outcomes, but this finding is incompletely understood. Guidelines themselves must change to be responsive to continuously evolving clinical practice. Our goal here was to investigate whether any relationship existed between the most recent ACC/AHA recommended indications for PCI and short term in-hospital outcomes. METHODS AND RESULTS: We analyzed the ACC National Cardiovascular Data Registry for the period of January 1, 2001, through March 31, 2004. We excluded PCI procedures performed for acute myocardial infarction (ST-segment elevation myocardial infarction); all others were grouped by their indications according to the standard ACC/AHA scheme: Class I, evidence and/or agreement that PCI is useful and effective; Class IIa, conflicting evidence and/or divergent opinions, weight is in favor; Class IIb, usefulness/efficacy is less well established; and Class III, evidence and/or agreement that PCI is not useful or effective and may be harmful. Clinical success was defined as angiographic success (<20% residual stenosis) at all lesions attempted without the adverse events of myocardial infarction, same-admission bypass surgery, or death. There were 412 617 PCI procedures included in the analysis. Frequency of indications was as follows: Class I, 64%; Class IIa, 21%; Class IIb, 7%; and Class III, 8%. Clinical success declined across the indications classes (92.8%, 91.7%, 89%, and 85.5%, respectively; P<0.001), whereas adverse events increased. CONCLUSIONS: In this large survey of contemporary PCI practice, most procedures were performed for Class I indications. A significant relationship between evidence-based indications recommended by the ACC/AHA Task Force and in-hospital outcomes was noted.
Cite This Study
Anderson et al. (2005) conducted an observational in Percutaneous coronary intervention (n=412,617). ACC/AHA indication class was evaluated on Clinical success (angiographic success <20% residual stenosis without MI, same-admission bypass surgery, or death) (p=<0.001). PCI performed for ACC/AHA Class I indications had higher clinical success (92.8%) compared to Class IIa (91.7%), Class IIb (89%), and Class III (85.5%) indications (P<0.001).