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Original research
Association between procedure appropriateness and patient-reported outcomes after percutaneous coronary intervention
  1. Jesse Xiaolong Yang1,
  2. Margaret J Stevenson2,
  3. Linda Valsdottir1,3,
  4. Kalon Ho1,
  5. John A Spertus4,
  6. Robert W Yeh1,3,
  7. Jordan B Strom1,3
  1. 1 Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3 Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  4. 4 Section of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  1. Correspondence to Dr Jordan B Strom, Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; jstrom{at}


Objective The Appropriate Use Criteria (AUC) has been used to identify individuals who are likely to benefit from percutaneous coronary intervention (PCI) for stable ischaemic heart disease. However, whether physicians reliably grade PCI appropriateness and whether AUC categories stratify symptomatic improvement in real-world practice are unclear.

Methods Patient-reported outcomes measures (PROMs) for angina (Seattle Angina Questionnaire (SAQ-7)), dyspnoea (Rose Dyspnea Scale (RDS)) and depression (Patient Health Questionnaire-2 (PHQ-2)) were collected on patients undergoing elective coronary angiography at an academic medical centre. Retrospectively, two physicians independently determined PCI appropriateness by the AUC criteria.

Results Inter-rater agreement on appropriateness was moderate (κ=0.48, 95% CI 0.32 to 0.63). Of PCI procedures evaluated, 57 (47.1%) were appropriate (A-PCI), 62 (51.2%) were maybe appropriate (MA-PCI) and 2 (1.6%) were rarely appropriate. At baseline, A-PCI compared with MA-PCI patients had worse RDS scores (2.0 vs 1.2, p=0.01). At 30 days, the change in SAQ-7 summary score was similar between groups (A-PCI vs MA-PCI, +27.1 vs +20.7, p=0.11). The mean change in RDS score was greater in A-PCI than MA-PCI (−1.0 vs −0.5, p for group by time interaction=0.03). PHQ-2 scores were similar and did not improve at 30 days.

Conclusion In patients undergoing PCI with PROMs collected before and 30 days after PCI, similar improvements in angina were observed regardless of appropriateness. Inter-rater agreement on PCI appropriateness was only moderate. Use of PROMs may improve reliability of physician assessments of PCI appropriateness.

  • percutaneous coronary intervention
  • quality and outcomes of care

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  • Contributors All authors listed made substantial contributions to the manuscript presented here. Contributions included data analysis, drafting the work and revising it for final approval. All authors have approved of the final product presented here.

  • Funding RWY and JBS are funded by grants from the National Heart, Lung, and Blood Institute (1R01HL136708-01 to RWY; 1K23HL144907 to JBS), outside of the submitted work. RWY reports additional support through an Innovation Grant from the Center for Healthcare Delivery Sciences at Beth Israel Deaconess Medical Center for the current project, as well as grant support from Boston Scientific and Abiomed, and consulting fees from Abbott, Medtronic and Teleflex, outside the submitted work. JAS reports research grants from Lilly, Novartis and Abbott Vascular.

  • Competing interests JAS has served as a consultant for Novartis, Amgen, Bayer and United Healthcare. He owns the copyright to the SAQ and has an equity interest in Health Outcomes Sciences. KH designed the Society for Cardiovascular Angiography and Interventions AUC mobile phone application.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the BIDMC Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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