Author Affiliations: Department of Health Care and Operations Management, Boston University School of Management, Boston, Massachusetts (Drs Restuccia and Shwartz); and Department of Medicine, Boston University School of Medicine, Boston (Dr Kreger) (email@example.com).
To The Editor: Dr Chan and colleagues pointed out an important dimension of appropriateness that they were unable to evaluate in their study, underuse of percutaneous coronary intervention (PCI).1 We conducted a study of appropriateness of cardiac procedures, including PCI, 2 decades ago that was limited to Medicare patients in Massachusetts but used criteria developed with methods similar to those used by Chan et al. We also found that PCI was appropriate for most of the patients who underwent this procedure.2 However, we were able to measure the rate of underuse by assessing the potential appropriateness of revascularization among coronary disease patients who had coronary angiography during a hospitalization but who did not receive revascularization within 3 months of that hospitalization. Approximately 64% of these patients met appropriateness criteria for revascularization, suggesting that a substantial portion of patients who have no intervention might benefit from the procedure.
Restuccia JD, Shwartz M, Kreger BE. Underuse of Percutaneous Coronary Intervention. JAMA. 2011;306(19):2094-2095. doi:10.1001/jama.2011.1658