Assessment of Indications for Percutaneous Coronary Intervention: A Multicenter Analysis after the Diagnosis of Chronic Coronary Syndrome.

Abstract

Percutaneous coronary intervention (PCI) is performed 300 000 times a year in Germany. Half of these procedures involve patients with chronic coronary syndrome. Little information is available on the quality of decision-making about the indication for PCI in this patient group. The Center for Health Services Research of the German Cardiac Society (<i>Zentrum für kardiologische Versorgungsforschung der Deutschen Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e.V.,</i> DGK-ZfKVF), in collaboration with the Initiative on Quality in Medicine (<i>Initiative Qualitätsmedizin e.V.,</i> IQM) carried out this study, in which the indication for PCI in randomly selected patients with chronic coronary syndrome was reviewed by peers on site. 441 assessment forms from 16 hospitals were included in the study. More than half of the patients (52.2%) had typical chest pain, 20.1% had mainly dyspnea, 17.7% had chest pain and dyspnea, and 10% had no symptoms. Three-quarters had symptoms or ischemia despite optimal drug treatment. Most patients were treated for clinical symptoms and proven ischemia or stenosis of more than 90%. In 11% of patients, the indication was complete revascularization as a staged procedure after a prior myocardial infarction treated with PCI. 73.7% of indications for PCI were judged to be in adherence to the guidelines; guideline adherence was judged to be questionable in 24.1% and to be absent in 2.2%. These data on the quality of indications for elective PCI reveal a need for improvement in adherence to the recommendations of the current German and international guidelines. In particular, the non-invasive or invasive proof of ischemia should be performed more frequently. These findings underscore the importance of peer review of indications for interventional procedures.