What are the most common clinical scenarios that cause a PCI case to be deemed INAPPROPRIATE by AUC?

Transcription

1 What are the most common clinical scenarios that cause a PCI case to be deemed INAPPROPRIATE by AUC? Michael A. Kutcher, MD, FSCAI Henry S. Jennings, III, MD, FSCAI

2 The SCAI-Quality Improvement Toolkit was developed with founding support from Daiichi Sankyo, Inc., and Lilly USA, LLC., and support from AstraZeneca. The Society gratefully acknowledges this support while taking sole responsibility for all content developed and disseminated through this effort.

3 AUC Indication #3 STEMI >12 hours from symptom onset Asymptomatic No hemodynamic instability and No electrical instability Accessed on August 15, 2012

4 AUC Indication #12 Asymptomatic or CCS 1 or 2 with: No prior CABG surgery 1- or 2-vessel CAD without proximal LAD involvement No or low-risk non-invasive test results No or sub-optimal anti-anginal medical therapy Accessed on August 15, 2012

5 AUC Indication #13 Asymptomatic with: No prior CABG surgery 1- or 2-vessel CAD without proximal LAD involvement Low-risk non-invasive test results On optimal anti-anginal medical therapy Accessed on August 15, 2012

6 AUC Indication #14 Asymptomatic with: No prior CABG surgery 1- or 2-vessel CAD without proximal LAD involvement Intermediate risk on non-invasive test results No or sub-optimal anti-anginal medical therapy Accessed on August 15, 2012

7 What is optimal anti-anginal therapy? In addition to aspirin: Two different classes of anti-anginal therapy such as: Beta blockers Long-acting nitrates Patel MR et al. J Am Coll Cardiol 2012

8 ACS Patients The only inappropriate indication for PCI in the acute setting was STEMI patients >12 hours from symptom onset who were asymptomatic or with only CCS Class 1 symptoms. Accessed on August 15, 2012

9 Non-ACS Patients 66% occurred in asymptomatic or CCS 1 patients. 71% occurred in patients with either a negative or low-risk non-invasive ischemic test result. 60% occurred in patients with 1-2 non-lad disease, on no anti-ischemic medical therapy, with no or mild angina, and with low-risk noninvasive studies for ischemia. Accessed on August 15, 2012

10 You may disagree with the AUC philosophy and format but it is a current reality and is being increasingly scrutinized in this new era of healthcare reform. It is better to be proactive than reactive. Bond with your nurses, PAs, cath lab staff, and data coordinators. Document, document, document! If you do not document to a reviewer it does not exist!!!

11 Be extra thoughtful before proceeding with ad hoc PCI or in situations where you are not the primary cardiologist and/or do not know the patient well. If you participate in the NCDR CathPCI Registry, be aware that there are new tools to assess AUC before submitting quarterly data. This may allow for legitimate challenges and adjudicated corrections if clinical documentation has not been incorporated into the database.

12 Use the new web-based SCAI AUC Calculator found at and create an icon for your smart phone, tablet, or computer. Tape a list or poster of the most common inappropriate clinical scenarios in your examination rooms, cath labs, and dictation areas. Use these lists or posters as a check sheet for time out before proceeding with PCI.

13 If you have feedback, questions, or suggestions for current or future SCAI-QIT Tip of the Month topics, please submit them at or to the s listed below: Michael A. Kutcher, MD, FSCAI Henry S. Jennings, III, MD, FSCAI

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