In the Journals

Experts outline measures to improve quality of PCI

Experts from four societies have recently published the first performance measure set designed specifically for PCI, addressing both ambulatory and inpatient settings.

The document, which features input from the American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, and the American Medical Association, focuses primarily on elective PCI and includes 11 measures that emphasize careful documentation of patient selection and procedure appropriateness. According to the authors of the document, these steps, which ensure high-quality clinical care for PCI, have been underutilized and could potentially serve as vehicles to accelerate appropriate translation of scientific evidence into clinical practice.

The four quality measures the authors cite are an appropriate reason for elective PCI; the use of embolic protection devices during saphenous vein bypass graft disease treatment; radiation dose documentation; and the annual volume of PCIs performed by the physician during the past 2 years.


Brahmajee K. Nallamothu

The performance measures, which entail the remaining seven metrics, include:

  • Comprehensive documentation of PCI indication;
  • Assessment of patients’ ability to receive dual antiplatelet therapy;
  • Evaluation of renal function before the procedure and contrast used during the procedure;
  • Prescription of optimal medical therapy at discharge;
  • Referral to cardiac rehabilitation;
  • Participation in a regional or national PCI registry;
  • The average annual volume of PCIs performed by the hospital during the past year.

“Through these measures, we have moved beyond simple measurement of a few treatments to incorporating key concepts like appropriateness,” said Brahmajee K. Nallamothu, MD, writing committee member and associate professor of cardiovascular medicine at the University of Michigan, Ann Arbor. “There is still much more work to be done, however, and an important part of this process was to identify important areas for future investigation.”

Specifically, Nallamothu and colleagues highlight four areas that should be further investigated to generate better performance measures, including measuring the filling of prescriptions and optimal dosing; limitations of current PCI data systems; shared accountability; and patient surveys.

Disclosure: Nallamothu reports serving as a consultant for Prescription Solutions and receiving financial support from Abbott Vascular. See the study for a full list of authors’ relevant financial disclosures.