1. Appropriateness of Coronary Revascularization for Patients Without Acute Coronary Syndromes
Edward L. Hannan, PhD; Kimberly Cozzens, MA; Zaza Samadashvili, MDl Gary Walford, MDl Alice K. Jacobs, MD; David R. Holmes, Jr., MD; Nicholas J. Stamato, MD; Samin Sharma, MD; Ferdinand J. Venditti, MD; Icilma Fergus, MD; Spencer B. King III, MD

2. Disclosures
Samin Sharma: Boston Scientific Inc, Abbott Vascular, Lilly, and The Medicine Co.
Alice K. Jacobs: Xience V Everolimus Eluting Coronary Stent System (EECSS) USA Post-Approval Study.

3. Objective
To determine appropriateness of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery performed in New York for patients without acute coronary syndrome (ACS) or previous CABG surgery.
J Am Coll Cardiol 2012;59:1870-6

4. Background
The American College of Cardiology Foundation (ACCF) and six other societies recently published joint appropriateness criteria for coronary revascularization.
J Am Coll Cardiol 2012;59:1870-6

5. Methods
Data from patients who underwent CABG surgery and PCI without acute coronary syndrome or previous CABG surgery in New York in were used to assess appropriateness and to examine the variation across hospitals in inappropriateness ratings.
J Am Coll Cardiol 2012;59:1870-6

6. Results
Of the 8,168 patients undergoing CABG surgery in New York without ACS/prior CABG who could be rated, 90.0% were appropriate for revascularization, 1.1% were inappropriate, and 8.6% were uncertain.
Of the 33,970 PCI patients eligible for rating, 28% lacked sufficient information to be rated.
Of the PCI patients who could be rated, 36.1% were appropriate, 14.3% were inappropriate, and 49.6% were uncertain.
A total of 91% of the patients undergoing PCI who were classified as inappropriate had 1- or 2-vessel disease without proximal LAD disease and had no or minimal anti-ischemic medical therapy.
J Am Coll Cardiol 2012;59:1870-6

7. Rating Cases as Appropriate for Revascularization Per ACCF/AHA Appropriate Use Criteria (Patients with No ACS/No Prior Bypass) New York 7/01/09-12/31/10
J Am Coll Cardiol 2012;59:1870-6

8. Most Common Clinical Scenarios for CABG Surgery Patients with No ACS/No Prior Bypass
J Am Coll Cardiol 2012;59:1870-6

9. Most Common Clinical Scenarios for PCI Patients with No ACS/No Prior Bypass
J Am Coll Cardiol 2012;59:1870-6

10. Hospital PCI Inappropriateness Percentages
J Am Coll Cardiol 2012;59:1870-6

11. Exploration of No ACS/No Prior Bypass Eligible Cases with No Rating
J Am Coll Cardiol 2012;59:1870-6

12. Conclusions
For patients without ACS/prior CABG, only 1% of patients undergoing CABG surgery who could be rated were found to be inappropriate for the procedure according to the ACCF appropriateness criteria
14% of the PCI patients who could be rated were found to be inappropriate
28% lacked enough noninvasive test information to be rated
J Am Coll Cardiol 2012;59:1870-6