The Appropriate Use of Percutaneous Coronary Intervention in Contemporary Clinical Practice

Abstract

Percutaneous coronary intervention (PCI) is common and generally low risk. Although shown to be of significant benefit in certain clinical situations, especially in the context of acute coronary syndromes, there exist clinical scenarios where PCI has not been shown to be helpful. In these cases, the risk of periprocedural complications as well as longer term issues such as bleeding or stent thrombosis mean that PCI may potentially be harmful. To inform best clinical practice, we now have published recommendations with regards to the Appropriate Use Criteria (AUC) for coronary revascularisation. The goal of the AUC is to guide physician decision-making and future research as well as to label coronary revascularisation more clearly for patients and payors in regards to its expected benefits in certain situations. In this review, we summarise and discuss the more clinically relevant of these AUC, either because they are contentious or of particular relevance to the local context or practice. We conclude that there continue to be situations whereby inappropriate PCIs are performed, and these represent opportunities for quality improvement.