{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:25:10Z","timestamp":1761863110675},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Measurement of hospital quality has traditionally focused on processes of care and postprocedure outcomes. Appropriateness measures for percutaneous coronary intervention (PCI) assess quality as it relates to patient selection and the decision to perform PCI. The association between patient selection for PCI and processes of care and postprocedural outcomes is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We included 203 531 patients undergoing nonacute (elective) PCI from 779 hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry between July 2009 and April 2011. We examined the association between a hospital's proportion of nonacute PCIs categorized as inappropriate by the 2009 Appropriate Use Criteria (AUC) for Coronary Revascularization and in-hospital mortality, bleeding complications, and use of optimal guideline-directed medical therapy at discharge (ie, aspirin, thienopyridines, and statins). When categorized as hospital tertiles, the range of inappropriate PCI was 0.0% to 8.1% in the lowest tertile, 8.1% to 15.2% in the middle tertile, and 15.2% to 58.6% in the highest tertile. Compared with lowest-tertile hospitals, mortality was not significantly different at middle-tertile (adjusted odds ratio [OR], 0.93; 95% confidence interval [CI], 0.73\u20131.19) or highest-tertile hospitals (OR, 1.12; 95% CI, 0.88\u20131.43;\n              <jats:italic>P<\/jats:italic>\n              =0.35 for differences between tertiles). Similarly, risk-adjusted bleeding did not vary significantly (middle-tertile OR, 1.13; 95% CI, 1.02\u20131.16; highest-tertile OR, 1.02; 95% CI, 0.91\u20131.16;\n              <jats:italic>P<\/jats:italic>\n              =0.07 for differences between tertiles) nor did use of optimal medical therapy at discharge (85.3% versus 85.7% versus 85.2%;\n              <jats:italic>P<\/jats:italic>\n              =0.58).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In a national cohort of nonacute PCIs, a hospital's proportion of inappropriate PCIs was not associated with in-hospital mortality, bleeding, or medical therapy at discharge. This suggests PCI appropriateness measures aspects of hospital PCI quality that are independent of how well the procedure is performed. Therefore, PCI appropriateness and postprocedural outcomes are both important metrics to inform PCI quality.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.112.966044","type":"journal-article","created":{"date-parts":[[2012,5,11]],"date-time":"2012-05-11T03:25:19Z","timestamp":1336706719000},"page":"290-297","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Hospital Percutaneous Coronary Intervention Appropriateness and In-Hospital Procedural Outcomes"],"prefix":"10.1161","volume":"5","author":[{"given":"Steven M.","family":"Bradley","sequence":"first","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul S.","family":"Chan","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin F.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manesh R.","family":"Patel","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Vernon","family":"Anderson","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry H.","family":"Ting","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"Rumsfeld","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brahmajee K.","family":"Nallamothu","sequence":"additional","affiliation":[{"name":"From the VA Eastern Colorado Health Care System and the University of Colorado\u2013Denver, Denver, CO (S.M.B., J.S.R.); Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO (P.S.C., J.A.S., K.F.K.); Duke University Medical Center, Durham, NC (P.S.D., M.R.P.); University of Texas Health Science Center, Houston, TX (H.V.A.); Mayo Clinic College of Medicine, Rochester, MN (H.H.T.); and University of Michigan Medical School, Ann Arbor, MI (B.K.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.018234"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.003"},{"key":"e_1_3_3_4_2","first-page":"20","article-title":"Bringing measurement and management science to the cath laboratory: the National Cardiovascular Data Registry (ACC-NCDR) and the Cardiac Catheterization Laboratory Continuous Quality Improvement Toolkit (ACC-CathKIT)","volume":"15","author":"Dehmer GJ","year":"2004","unstructured":"Dehmer GJ, Elma M, Hewitt K, Brindis RG . 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