Appropriate use criteria and percutaneous coronary intervention: Measuring patient selection quality

The Appropriate Use Criteria (AUC) for Coronary Revascularization represent an effort by national professional societies to assess the quality of patient selection for procedures, such as percutaneous coronary intervention (PCI). The AUC focus on whether and when PCI should be performed, and complement traditional PCI quality metrics that focus on how well PCI is performed (e.g., postprocedural processes of care and outcomes). Such quality metrics help ensure that patients who undergo PCI have a high likelihood of clinical benefit, while minimizing the potential for procedural risk. Tools like the AUC are potentially important since, in real-world settings, large variations exist in hospital rates of PCI appropriateness for nonacute indications and can improve patient selection at facilities with high rates of inappropriate PCI. Ongoing efforts to verify the accuracy of key variables used in adjudicating PCI appropriateness and to update the AUC as new evidence emerges will ensure that the AUC are dynamic quality improvement tools that can facilitate high-quality PCI.