The debate over the appropriate use of percutaneous coronary interventions began brewing again as cardiologists argue over the guidelines for ordering the procedures and a study hints at substantial overuse.
A recent study of more than 1 million PCIs performed at nearly 700 hospitals found that around 4% were conducted in patients without clear indication.
"On average, our findings are not too bad–just 4% of PCIs fall outside approved indications, but some hospitals are doing PCI for more unclear indications on a fairly regular basis," lead author Dr. Peter Cram told Heartwire.
Unclear indication isn’t necessarily indicative of an inappropriate procedure, study authors said, but it raised eyebrows.
"Although a 4% rate of potentially inappropriate procedures with unclear indications may seem small, if 1 in 25 PCI procedures could be avoided, the economic impact could be substantial," researchers wrote. "Extrapolating our findings to the estimated 600,000 PCIs performed each year in the U.S., 24,000 of these procedures might be avoidable. Assuming an average reimbursement of $35,000 per procedure, this would translate into a cost of $840 million per year."
Meanwhile, some cardiologists have begun to criticize the standards by which appropriateness is defined, arguing that there are too many assumptions and too much variability going into determining whether a given procedure followed guidelines.
"The problem is that we are no closer to being able to identify overuse based upon these appropriate-use criteria than before they were created," Dr. Steven Marso, an author on a paper published in February’s Journal of the American College of Cardiology: Cardiovascular Interventions told Heartwire.