Abstract 6982: PCI Appropriateness of Use: Trends Over the Last Decade

Introduction: The Appropriate Use Criteria (AUC) for coronary revascularization have undergone 2 revisions, reflecting improved understanding of which situations percutaneous coronary intervention (PCI) optimizes patient care. Over this time, PCI appropriateness and volumes have changed with increased compliance. Accordingly, we analyzed these changes in detail. Methods: PubMed and Embase libraries identified 9 national studies evaluating appropriate use of PCI. Case appropriateness was classified as appropriate, inappropriate/rarely appropriate, uncertain/may be appropriate and unmappable. Temporal trends for each category were determined from linear regression. Student-t-test was used to compare groups using Graphpad Prism 8.0 software. Results: The total number of PCIs decreased 14.1% over the study period. This diminished volume was associated with reductions in both non-acute (from 22.5% to 16.3%, p <0.01) and non-mappable PCIs (from 17.6% to 5.0%, p<0.001), while acute PCIs increased (from 65.7% to 81.2%, p<0.001, figure). In non-acute PCIs, appropriate PCIs increased (from 42.8% to 68.4%, p<0.001) while both inappropriate (from 18.9% to 11.6%, p<0.01) and uncertain (from 38.2% to 20.0%, p<0.001) were reduced. Reclassification as defined in the 2017 Revision led to significant decrease in appropriate (56.8% to 48.0%, p<0.01) and an increase in uncertain class (32.7% to 50.1%, p <0.01). Acute PCIs showed no overall change in appropriateness. Conclusions: These findings demonstrate: 1) the overall volume of PCIs is decreasing, 2) revised classification led to more uncertain PCIs, and 3) the percent of appropriate non-acute PCIs is increasing with a decline in inappropriate and uncertain PCI. The AUC have successfully decreased the performance of inappropriate/rarely appropriate PCIs. These trends suggest either that more appropriate non-acute PCIs are being performed or better documentation has led to more accurate classification.