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. 2013 Dec 17;62(24):2274-81.
doi: 10.1016/j.jacc.2013.07.086. Epub 2013 Sep 18.

Patient and hospital characteristics associated with inappropriate percutaneous coronary interventions

Paul S Chan  1 , Sunil V Rao  2 , Deepak L Bhatt  3 , John S Rumsfeld  4 , Hitinder S Gurm  5 , Brahmajee K Nallamothu  6 , Matthew A Cavender  7 , Kevin F Kennedy  8 , John A Spertus  9
Affiliations

Patient and hospital characteristics associated with inappropriate percutaneous coronary interventions

Paul S Chan et al. J Am Coll Cardiol. .

Abstract

Objectives: This study sought to examine whether rates of inappropriate percutaneous coronary intervention (PCI) differ by demographic characteristics and insurance status.

Background: Prior studies have found that blacks, women, and those who have public or no health insurance are less likely to undergo PCI. Whether this reflects potential overuse in whites, men, and privately insured patients, in addition to underuse in disadvantaged populations, is unknown.

Methods: Within the National Cardiovascular Data Registry CathPCI Registry, we identified 221,254 nonacute PCIs performed between July 2009 and March 2011. The appropriateness of PCI was determined using the Appropriate Use Criteria for coronary revascularization. Multivariable hierarchical regression was used to evaluate the association between patient demographics and insurance status and inappropriate PCI, as defined by the Appropriate Use Criteria.

Results: Of 211,254 nonacute PCIs, 25,749 (12.2%) were classified as inappropriate. After multivariable adjustment, men (adjusted odd ratio [OR]: 1.08 [95% CI: 1.05 to 1.11]; p < 0.001) and whites (adjusted OR: 1.09 [95% CI: 1.05 to 1.14]; p < 0.001) were more likely to undergo an inappropriate PCI in comparison with women and nonwhites. Compared with privately insured patients, those who had Medicare (adjusted OR: 0.85 [95% CI: 0.83 to 0.88]), other public insurance (adjusted OR: 0.78 [95% CI: 0.73 to 0.83]), and no insurance (adjusted OR: 0.56 [95% CI: 0.50 to 0.61]) were less likely to undergo an inappropriate PCI (p < 0.001). In addition, compared with urban hospitals, those admitted at rural hospitals were less likely to undergo inappropriate PCI, whereas those at suburban hospitals were more likely.

Conclusions: For nonacute indications, PCIs categorized as inappropriate were more commonly performed in men, whites, and those who had private insurance. Higher rates of PCI in these patient populations may, in part, be due to procedural overuse.

Keywords: CI; OR; PCI; confidence interval; disparities; odds ratio; overuse; percutaneous coronary intervention; quality of care.

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Figures

Figure 1
Figure 1. Study cohort
Patients excluded from the study cohort are depicted.
See this image and copyright information in PMC

Comment in

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