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Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary
John T Saxon1,2, J Aaron Grantham1,2, Adam C Salisbury1,2
1Saint Luke's Mid America Heart Institute, Kansas City, MO (J.T.S., J.A.G., A.C.S., Y.T., D.J.C., J.A.S., D.M.S.).
Insights
Appropriate use criteria for chronic total occlusion percutaneous coronary intervention (PCI) are linked to better health outcomes. Appropriate PCI procedures showed the greatest improvement in patient health status at one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- American College of Cardiology/American Heart Association Appropriate Use Criteria guide clinical decisions.
- The impact of these criteria on health status after chronic total occlusion percutaneous coronary intervention (PCI) was previously unknown.
Purpose of the Study:
- To evaluate the association between appropriate use criteria categories and health status outcomes following chronic total occlusion PCI.
- To determine if adherence to guidelines correlates with patient-reported benefits.
Main Methods:
- Analysis of 769 patients with baseline and 1-year health status data post-chronic total occlusion PCI.
- Categorization of procedures into 'appropriate,' 'may be appropriate,' and 'rarely appropriate' based on criteria.
- Comparison of mean changes in Seattle Angina Questionnaire (SAQ) scores across categories.
Main Results:
- Appropriate use criteria were met in 74.5% of cases, with 24.8% classified as 'may be appropriate.'
- Patients in the 'appropriate' group showed significantly greater improvement in SAQ summary scores (27.3 points) compared to the 'may be appropriate' group (22.5 points).
- The 'appropriate' group also demonstrated a higher proportion of very large improvements in health status.
Conclusions:
- A high rate of appropriate PCI was observed for chronic total occlusion, with a low rate of rarely appropriate procedures.
- Appropriate PCI indication was associated with the most substantial health status improvements at one year.
- A significant number of patients in the 'may be appropriate' category also experienced meaningful health benefits.
Background:
The American College of Cardiology/American Heart Association Appropriate Use Criteria were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion percutaneous coronary intervention (PCI) is unknown.
Methods:
We analyzed 769 patients with baseline and 1-year health status data after chronic total occlusion PCI. Procedures were categorized as appropriate, may be appropriate, or rarely appropriate. Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across appropriate use criteria categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤10 points), intermediate (10-19 points), large (20-29 points), and very large (≥30 points).
Results:
The appropriate use criteria indication was appropriate in 573 patients (74.5%), may be appropriate in 191 (24.8%), and rarely appropriate in 5 (0.7%). Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3±21.3 points) at 1 year compared with the may be appropriate (22.5±20.9; P=0.01). A similar pattern was noted for SAQ angina frequency (mean change 24.0±27.2 versus 18.7±25.6; P=0.02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% versus 33.3%; P=0.01).
Conclusions:
Among patients undergoing chronic total occlusion PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well.
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