Revised PCI guidelines not being followed
MedWire News: The Occluded Artery Trial (OAT) results and consequent revised guidelines for appropriate percutaneous coronary intervention (PCI) have not been fully incorporated into US clinical practice, a study reveals.
"Many stable patients with recent myocardial infarction (MI) and persistent infarct artery occlusion continue to undergo a costly and ineffective procedure," write Marc Deyell and colleagues (University of British Columbia, Vancouver, Canada) in the Archives of Internal Medicine.
The OAT, conducted in 2006, examined the effects of PCI on totally occluded infarct-related arteries (IRAs) conducted a minimum of 24 hours on calendar days 3-28 after MI. The trial demonstrated no reduction in death, reinfarction, or end-stage heart failure, and led to revised guidelines being issued by the American College of Cardiology and the American Heart Association.
The present study set out to determine whether these guideline revisions have been implemented in US clinical practice.
The researchers used the CathPCI registry to identify patients with a totally occluded native coronary artery undergoing catheterization more than 24 hours after MI. They examined trends among hospitals in the highest quartile for reporting of diagnostic procedures.
The study included 28,780 patient visits from 896 hospitals. PCI was performed in 11,083 patients before OAT publication, 7838 between publication and guideline revision, and 9859 after guideline revision.
After adjusting for covariates adapted from mortality risk factors for the CathPCI database, there was no overall decrease in the monthly rate of PCI performed for occlusions after OAT publication (odds ratio [OR]=0.997) or after guideline revision (OR=1.007).
Among hospitals consistently reporting diagnostic catheterizations, there was no significant decline in PCI rate after OAT publication (OR=1.018) but there was a small decrease after guideline revision (OR=0.963).
In a related commentary, Mauro Moscucci (University of Miami, Florida, USA) wrote: "We must heed the call to professional responsibility aimed at the elimination of tests and treatments that do not result in any benefit for our patients, and for which the net effects will be added costs, waste, and possible harm."
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By Piriya Mahendra