Inappropriate PCI is more likely to occur in men, white patients and privately insured patients, according to a study published in the September issue of the Journal of the American College of Cardiology. The higher rates among these patients could be partly due to overuse.
“Prior studies have found that blacks, women and those with 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,” wrote the authors, led by Paul S. Chan, MD, of Saint Luke’s Mid America Heart Institute in Kansas City, Mo.
Using the National Cardiovascular Data Registry CathPCI Registry, the researchers identified 211,254 non-acute PCIs done between 2009 and 2011. They used Appropriate Use Criteria (AUC) for coronary revascularization to determine whether the procedures were appropriate.
Using the AUC, they found that one in eight PCIs in stable patients was considered inappropriate. Nearly 50 percent of the procedures (105,121) were classified as appropriate. There were 80,384 (38.1 percent) classified as uncertain and 25,749 (12.2 percent) classified as inappropriate.
After adjusting for multiple variables, men (8 percent more likely than women) and white patients (9 percent more likely than blacks) underwent an inappropriate PCI more often. Privately insured patients were also more likely to have an inappropriate PCI.
The researchers also linked certain hospital characteristics with inappropriate PCI. Inappropriate PCI was less likely to occur at rural hospitals when compared with urban hospitals, and patients in suburban hospitals were more likely to receive inappropriate PCI. They did not link inappropriate PCI to hospital status or to onsite cardiothoracic surgery. Hospital characteristics also did not interact with patient characteristics.
Inappropriate PCI was most often performed in patients with no prior history of coronary artery bypass surgery, single to two-vessel non-high risk coronary artery disease, minimal to no anti-anginal therapy and either a low or intermediate risk for ischemia.
“While the clinical magnitude of these differences was modest, it represents over 2,000 additional procedures per year in which male and white patients may be exposed to procedural and long-term bleeding risks without clear clinical benefit over that of medical therapy,” the authors wrote.