A Perspective on the Appropriate Use of Angioplasty and Stents

Ralph Brindis, MD, MPH, FACCDr. Ralph Brindis is the Immediate Past President of the American College of Cardiology and helmed the National Cardiovascular Data Registry (NCDR) since its inception in 1997 — this is the registry that was the source for the data analyzed and reported in yesterday’s JAMA study, “Appropriateness of Percutaneous Coronary Intervention.

In my exclusive interview with Dr. Brindis, I talked with him about the study, his feeling about what it showed, both the positive findings and what he calls “opportunities for improvement.” While there was almost 100% adherence to guidelines for acute angioplasties (which made up 71% of the total angioplasties performed) the study also pinpointed the fact that PCIs for non-acute patients had a higher rate of “inappropriates”, as defined by the ACC/SCAI Appropriateness Criteria — and that this rate varied widely from hospital to hospital. This means that those hospitals with higher than average “inappropriate” PCIs needed to look at their cases, their decision-making process and work to bring it closer to the norm.

The crazy thing about much of the news reporting about the publication of this study in JAMA is the implication that an “investigative team uncovered previously unreported data” and exposed the fact that “up to half of angioplasties performed may not be beneficial.”

The fact is that none of this data would exist if it were not for the ACC, SCAI and physicians like Dr. Brindis, who is a co-author of the JAMA study. And the point of the study was specifically to take a “look-see” at how PCIs were being done in the U.S. and that look showed only 4% of all PCIs could be classified as “inappropriate”. Most importantly, the study showed precisely where the inappropriates were happening, and opened up a discussion about how to reduce that number and improve the use of angioplasty.

Speaking of inappropriate, I’ll be discussing the inaccurate reporting of this study by most of the mainstream media in an upcoming post, but for now, read over our interview with Dr. Brindis. (We’ll be posting a companion piece, talking to the study’s lead author, Dr. Paul Chan, tomorrow.)

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Filed under Appropriate Use Criteria (AUC), Interviews, Media Coverage

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