Percutaneous coronary intervention use in the United States: defining measures of appropriateness

Appropriate utilization of percutaneous coronary intervention (PCI) and medical therapy is deservedly a national healthcare policy priority for the United States. Because PCI is both common and costly, appraisal of appropriateness is warranted. The initial appropriate use criteria (AUC) have been developed for coronary revascularization procedures and investigators recently reported the appropriateness for the approximately 500,000 PCI procedures performed at centers participating in the National Cardiovascular Data Registry. The AUC have broad implications for both healthcare providers and our patients and will be used as the basis for indications, referral patterns, treatment options, physician education, shared decision-making, and reimbursement for years to come. While we acknowledge the importance of thoughtfully assessing appropriateness for all medical procedures including PCI, there are a number of concerns with the current AUC and methods used to report appropriateness that warrant expanded commentary.