|Completely Fulfills Attribute∗||Partially Fulfills or Does Not Fulfill Attribute∗||Summary Comments§|
|Measures included in the performance measure set|
|Comprehensive Documentation of PCI†||1,2,3,4|
|Appropriate Indication for Elective PCI‡||1,2,3b,4||3a||Lack of existing data on use in test populations makes it difficult to know whether the current measure accurately captures “appropriateness” (as opposed to encouraging gaming) or whether it will lead to unintended consequences by punishing providers.|
|Assessment of Candidacy for Dual-Antiplatelet Therapy†||1,2,4||3||ACCF National Cardiovascular Data Registry CathPCI Registry is unable to measure this. It will require additional chart documentation and abstraction.|
|Use of Embolic Protection Devices in the Treatment of Saphenous Vein Bypass Graft Disease‡||2,3b,4||1b, 3a||The guideline Class of Recommendation is 1, and Level of Evidence is only B.|
|Documentation of Preprocedural Glomerular Filtration Rate and Contrast Dose Used During the Procedure‡||2,3,4||1||There are few potential unintended consequences, given that there are no thresholds specified in this measure. However, evidence indicates that doses are inconsistently documented. Therefore, although this measure is expected to have limited impact because it requires only documentation, it is an intermediate step to a more meaningful performance measure.|
|Radiation Dose Documented‡||2,3,4||1||There are few potential unintended consequences given that there are no thresholds specified in this measure. However, evidence indicates that doses are inconsistently documented. Therefore, although this measure is expected to have limited impact because it requires only documentation, it is an intermediate step to a more meaningful performance measure.|
|Postprocedural Optimal Medical Therapy Composite†||1,2,3,4||Registry data are currently limited, making it unfeasible to capture specific medical, patient, or system exceptions.|
|Cardiac Rehabilitation Patient Referral†||1,2,3,4|
|Regional or National PCI Registry Participation†||2,3,4||1||The guideline Class of Recommendation is 1, but Level of Evidence is only C.|
|Annual Operator PCI Volume‡||2,3b||1,3a,4|
|Annual Hospital PCI Volume†||2,3||1,4||Smaller hospitals might be more inclined to intervene when the procedure is not indicated, to achieve higher volumes.|
|Measures considered but not included in the performance measure set|
|Assessment of patient knowledge of benefits and risks of PCI||1,4b||2,3,4a|
|Postprocedural blood transfusion||1||3,4||Bleeding might occur outside interventionalists’ locus of control.|
|Measurement of cardiac biomarkers||N/A||1,2,3,4||Evidence is still controversial.|
|Periprocedural angina assessment||1,2||3,4||This is a potentially high-impact area with validated instruments, yet little data exist on how to best incorporate validated instruments into routine practice without excessive effort or costs.|
|Aspirin/thienopyridine at discharge||3,4||1,2||There is little room for major impact or improvement, given existing evidence of already high compliance rates.|
ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; GFR, glomerular filtration rate; and PCI, percutaneous coronary intervention.
↵∗ Corresponding numbers and letters are linked to the ACC/AHA Task Force on Performance Measures Attributes for Performance Measures. Numbers indicate the entire attribute, and letters indicate specific attribute subcriteria.
↵† These measures are performance measures.
↵‡ Indicated in shading, these measures have been designated quality metrics. Quality metric are designated for use in internal quality-improvement programs only. These measures are not appropriate for any other purpose (e.g., pay-for-performance, physician ranking, or public reporting programs).
↵§ Where applicable, the writing committee provided summary comments about why certain measures were included or not included in the final measure set. For all attributes noted as “partially or does not fulfill attribute,” the writing committee provided summary comments.