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The article discusses the relevance of percutaneous coronary intervention (PCI), which is performed in about 600,000 cases in the U.S. per year and costs a total of 12 billion U.S. dollars. In a study conducted by the authors to understand the need for the procedure, they use data from the National Cardiovascular Data Registry between July 1, 2009 and September 30, 2010 with an aim of finding the proportion of appropriate, uncertain or inappropriate PCI. They conclude that most PCIs done in the U.S. were appropriate with only 12% being tagged as inappropriate.

Focuses on the National Cardiovascular Data Registry (ACC-NCDR) and the Cardiac Catheterization Laboratory Continuous Quality Improvement Kit in the U.S. Background on the development of the ACC-NCDR; Specific goals of ACC-NCDR; Improvement in the quality of care in the Cardiac Catheterization Laboratory.

Care of the patient before and after percutaneous coronary interventions has changed largely because of the increased use of stents. Important patient management issues include the evaluation of chest pain after the procedure, recognition of acute vessel closure during the periprocedural period, management of the vascular access site, and prevention of contrast-induced renal dysfunction. Risk factor modification and drug therapies are important interventions for the secondary prevention of coronary events. Functional testing has a meaningful role in the evaluation of some patients after coronary intervention. It is important for the specialist in internal medicine to have a firm working knowledge of the various aspects of patient care before and after these procedures because their role in the management of these patients is increasing. [Copyright &y& Elsevier]

The article presents the author's views on the use of appropriate use criteria (AUC) for coronary revascularization and its effects on medical care. Topics discussed includes application of AUC for readily adaptable for use as clinical decision support tools, implementation of AUC directive and the use of AUC as a mechanism to benchmark ordering patterns.

Background: Standardization of risk is critical in benchmarking and quality improvement efforts for percutaneous coronary interventions (PCIs). In 2018, the CathPCI Registry was updated to include additional variables to better classify higher-risk patients.Objectives: This study sought to develop a model for predicting in-hospital mortality risk following PCI incorporating these additional variables.Methods: Data from 706,263 PCIs performed between July 2018 and June 2019 at 1,608 sites were used to develop and validate a new full and pre-catheterization model to predict in-hospital mortality, and a simplified bedside risk score. The sample was randomly split into a development cohort (70%, n = 495,005) and a validation cohort (30%, n = 211,258). The authors created 1,000 bootstrapped samples of the development cohort and used stepwise selection logistic regression on each sample. The final model included variables that were selected in at least 70% of the bootstrapped samples and those identified a priori due to clinical relevance.Results: In-hospital mortality following PCI varied based on clinical presentation. Procedural urgency, cardiovascular instability, and level of consciousness after cardiac arrest were most predictive of in-hospital mortality. The full model performed well, with excellent discrimination (C-index: 0.943) in the validation cohort and good calibration across different clinical and procedural risk cohorts. The median hospital risk-standardized mortality rate was 1.9% and ranged from 1.1% to 3.3% (interquartile range: 1.7% to 2.1%).Conclusions: The risk of mortality following PCI can be predicted in contemporary practice by incorporating variables that reflect clinical acuity. This model, which includes data previously not captured, is a valid instrument for risk stratification and for quality improvement efforts. [ABSTRACT FROM AUTHOR]