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Can we improve the appropriateness of PCI?
  1. Suzanne V Arnold
  1. Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO 64111, USA
  1. Correspondence to Dr Suzanne V Arnold, Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO 64111, USA; suz.v.arnold{at}gmail.com

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Chronic angina substantially worsens patients’ quality of life1 2 and increases healthcare costs.3 Particularly now, in the post-ISCHEMIA era,4 relief of ischaemic symptoms should be a primary goal of percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD). As such, the appropriateness of PCI most often hinges on the degree of symptom improvement achieved. In their Heart article, Yang et al compared the symptomatic benefit (using the 7-item Seattle Angina Questionnaire (SAQ-7) and Rose Dyspnea Score (RDS)) of patients with stable CAD who were treated with PCI that was judged as appropriate versus maybe appropriate.5 The authors found similar improvement in angina-related health status regardless of the appropriateness status of the PCI and concluded that the current Appropriate Use Criteria (AUC) do not discriminate well between the patients who will versus will not benefit from PCI. They argue that patient-reported outcome measures could be used to improve the current AUC by potentially identifying those patients more likely to benefit from PCI. I note three key conclusions from this paper.

Patients with more symptoms have greater symptomatic benefit from PCI

The authors found that patients who underwent an appropriate PCI had statistically similar symptom benefit compared with those who underwent a maybe appropriate PCI. In contrast, symptoms prior to PCI were the strongest …

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Footnotes

  • Twitter @arnoldgehrke

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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