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CathPCI Registry
March 14, 2017
4:00 pm – 5:30 pm
Appropriate Use Criteria Session
Presenters:
Issam Moussa, MD, FACC, FSCAI
Gregory J. Dehmer, MD, MACC, MSCAI, FACP, FAHA
Melissa Nitta, MPH, BSN, RN
Objectives:
1.
2.
3.
4.
Identify the AUC methodology manuscripts
Summarize the purpose of the AUC
List the new AUC categories
Recognize v5 AUC significant data elements
Pre-Work:
1. Wolk, et al (2013). Multimodality Appropriate Use Criteria for the Detection and Risk
Assessment of Stable Ischemic Heart Disease. JACC Vol. 63;380-406
2. Patel, et al (2017). Appropriate Use Criteria for Coronary Revascularization in Patients with
Acute Coronary Syndromes. JACC Vol. 69;570-91
3. Patel, et al (2017). Appropriate Use Criteria for Coronary Revascularization in Patients with
Stable Ischemic Heart Disease (not published at time of support material generation; visit
www.onlinejacc.org and search under Issues after March 10, 2017 to view online!)
Notes/Outline:
I.
Why do we have Appropriate Use Criteria for Coronary Revascularization procedures?
a. Cost
b. Value
c. Variation in PCI
d. Quality
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e. Self-regulation
f.
II.
A benchmark for PCI Utilization
Documents that Affect Care
a. Performance Measures
b. Clinical Practice Guidelines
c. Appropriate Use Criteria
III.
How the AUC evolved
a. Changing terms
b. Multimodality documents
IV.
The new AUC for Coronary Artery Revascularization
a. Writing group
b. Rating panel
c. Influence of Clinical Trials
d. New PCI/STEMI Guidelines Focused Update
e. Appropriate Use Criteria for Acute Coronary Syndromes (STEMI, NSTEMI, Unstable
Angina)
f.
V.
Appropriate Use Criteria for Stable Ischemic Heart Disease
Review of v5 data elements that support AUC mapping
Frequently Used Terminology:
Appropriate Use Criteria (AUC) – weigh the expected health benefit against the expected health risk for
the procedure indication and are designed to be used as a tool by clinicians and patients when
considering the use of PCI as a treatment option.
Appropriate Care – PCI is viewed as being generally acceptable and a reasonable approach for the
indication. The health benefits are understood to outweigh the procedural risks. However, a rating of
appropriate does not mandate that a procedure or revascularization strategy be performed.
May be appropriate care – At times, an appropriate option for management of patients in this
population due to variable evidence or agreement regarding the risk-benefit ratio. PCI is generally
acceptable and may be a reasonable approach for the patient and can be considered by the patient and
provider.
Rarely appropriate care – this rating should not prevent a therapy from being performed. It is
anticipated that there will be some clinical scenarios rated as rarely appropriate where an alternative
therapy or performing revascularization may still be in the best interest of a particular patients. There is
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a lack of clear benefit/risk advantage to patients with this indication the procedure is not generally
acceptable and is not generally reasonable for the indication.
Culprit Stenosis – the artery/stenosis responsible for the acute coronary syndrome
Abbreviations
AA = Antianginal
ACS = Acute Coronary Syndrome
AUC = Appropriate Use Criteria
BB = Beta-blockers
CABG = Coronary Artery Bypass Graft
CAD = Coronary Artery Disease
FFR = Fractional Flow Reserve
IMA = Internal Mammary Artery
IRA = Infarct-Related Artery
LAD = Left Anterior Descending Coronary Artery
LVEF = Left Ventricular Ejection Fraction
PCI = Percutaneous Coronary Intervention
SIHD = Stable Ischemic Heart Disease
STEMI = ST-Segment Elevation Myocardial Infarction
NSTEMI = Non-ST Segment Elevation Myocardial Infarction
TIMI = Thrombolysis In Myocardial Infarction
Severity of disease is defined as:
 Severe:
a. A ≥70% luminal diameter narrowing of an
epicardial stenosis made by visual assessment
in the “worst view” angiographic projection; or
b. A ≥50% luminal diameter narrowing of the left
main artery made by visual assessment, in the
“worst view” angiographic projection.
 Intermediate:
c. A ≥50% and <70% diameter narrowing of an
epicardial stenosis made by visual assessment
in the “worst view” angiographic projection.
Action Items:
Please complete the following activities after attending this session:
1. Gain familiarity with all Appropriate Use Criteria (AUC) source materials and circulate to clinical
team
2. Review current documentation practices and evaluate opportunities for improvement in
capturing new AUC concepts
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3. Join the monthly Registry Site Manager calls occurring the 3rd Thursday of every month for
updates and discussions of the v5 dataset! The schedule is found on the ‘Education’ page and
the dial-in information appears on the registry landing page prior to the call.
4. Watch the registry landing page for Announcements specific to the v5 upgrade
5. Monitor the Documents Home Page for pertinent v5 resources which will be posted/available
when applied to the registry
6. Question(s)? Email [email protected]
Resources:



Wolk, et al (2013). Multimodality Appropriate Use Criteria for the Detection and Risk
Assessment of Stable Ischemic Heart Disease. JACC Vol. 63;380-406
Patel, et al (2017). Appropriate Use Criteria for Coronary Revascularization in Patients with
Acute Coronary Syndromes. JACC Vol. 69;570-91
Patel, et al (2017). Appropriate Use Criteria for Coronary Revascularization in Patients with
Stable Ischemic Heart Disease (not published at time of support material generation)
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