title: Utility of a real-time appropriate use criteria decision support application for percutaneous coronary interventions in non-acute coronary syndrome.
abstract: OBJECTIVE
  The aim of this study was to test the feasibility and value of a real-time online appropriate use criteria (AUC) application for percutaneous coronary intervention (PCI) in patients without acute coronary syndrome.
  
  
  BACKGROUND
  High rates of non-appropriate elective PCI in the National Cardiovascular Data Registry (NCDR) CathPCI Registry have created interest in integrating decision support tools into routine clinical care to improve the frequency of appropriate PCIs.
  
  
  METHODS
  Patients undergoing diagnostic coronary angiography and subsequent PCI for non-ACS indications at a single center were scored using a real-time AUC application pre-procedure. Blinded angiographic review was performed subsequently for each case. Rates of appropriate, inappropriate, uncertain and not rated PCIs were tabulated according to specific clinical scenarios using information available both before and after the angiographic audit.
  
  
  RESULTS
  Of 308 PCIs in 272 patients, 196 (63.6%) were deemed appropriate, 79 (25.6%) uncertain, and two (0.6%) inappropriate; 31 (10.1%) scenarios could not be rated. With angiographic audit, inappropriate PCIs increased to 9.7%. There was a significant improvement in the rate of appropriate PCI using the real-time AUC application compared with retrospective data collection for NCDR reporting (64% vs. 53%, P = 0.01).
  
  
  CONCLUSIONS
  Use of a real-time AUC application together with angiographic audit may improve the accuracy of reporting PCI appropriateness. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts. chen.stuart@gmail.com.
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Kalon K L
authors.initials: KK
authors.lastname: Ho
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Gannon
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Braghadheeswar
authors.initials: B
authors.lastname: Thyagarajan
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Anjan K
authors.initials: AK
authors.lastname: Chakrabarti
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Potter
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Anand
authors.initials: A
authors.lastname: Singla
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Piccirillo
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Christopher U
authors.initials: CU
authors.lastname: Meduri
authors.affiliation: Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachuetts.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
mesh_terms: D000368:Aged; D001900:Boston; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003661:Decision Support Techniques; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: appropriateness; coronary artery disease; quality improvement