Abstract Body (Do not enter title and authors here): Background: The “Appropriate Use Criteria for Coronary Revascularization” guide clinicians in delivering high-quality care and optimizing medical resource utilization. While previous studies have indicated an approximately 10% rate of inappropriateness of non-acute percutaneous coronary interventions (PCI), there is a lack of similar data in Brazil.
Research Question: This study sought to determine the rate of appropriate elective PCI at a cardiology reference hospital in Brazil.
Goals: The primary goal was to ascertain the frequency of elective PCI categorized as appropriate, potentially or rarely appropriate. The secondary objective aimed to identify patient characteristics associated with PCI inappropriateness.
Methods: In this retrospective study, we included stable patients with chronic coronary syndromes (CCS) who underwent elective PCI between 2017 and 2020 at a cardiology hospital in Sao Paulo, Brazil. The appropriateness of the PCI was assessed using the ACC/AHA criteria proposed in 2017. The adequacy of the procedure was assessed at the “territory level” of the coronary arteries (left main [LM], left anterior descending [LAD], circumflex [CX], and right coronary artery [RCA]). Clinical variables associated with rarely appropriate PCI were identified from the cohort of patients with single-vessel procedure.
Results: 467 patients underwent 474 elective PCI with 543 treated coronary territories. We classified 59 (10.9%), 263 (48.4%), and 221 (40.7%) PCI as rarely appropriate, possibly appropriate, and appropriate, respectively. Single-vessel PCI was found in 332 patients. Factors associated with an increased rate of rarely appropriate were male (OR 2.83, 95% CI 1.14-7.02), no symptoms (OR 8.24, 95% CI 3.79-17.91), and having a positive functional test (OR 13.12, 95% CI 3.94-43.72). Factors associated with a decreased rate of rarely appropriate were depending on the public health system (OR 0.20, 95% CI 0.095-0.43), previous myocardial infarction (OR 0.21, 95% CI 0.07-0.6), previous PCI (OR 0.22, 95% CI 0.08-0.63), and current use of beta-blockers (OR 0.24, 95% CI 0.12-0.49).
Conclusion: Rarely appropriate PCI was more prevalent among asymptomatic men with no previous myocardial infarction, not adequately medicated, and having a private health plan. These findings suggest a possible overuse of elective PCI in those patients, prompting health care providers to carefully review the indications of a costly, potentially risky procedure such as PCI.