Adjudicating coronary revascularization: Appropriate Use Criteria are flawed and have been misapplied

摘要

The 2009 Appropriate Use Criteria (AUC) for coronary revascularization were designed to optimize care given deficient practice guidelines. However, due to the constituency of its technical panel and limitations in methodology, the noble intent of the AUC has shifted to use as a punitive tool to eradicate perceived overuse of percutaneous coronary intervention (PCI). In analyzing the current literature, there does not appear to be significant PCI overuse. Moreover, several studies have identified PCI underuse and its resultant hazards. In the 2012 focused update, there has been no substantive change to its flawed conception and application. We describe problems related to the development of the AUC and its use in clinical practice, suggesting several modifications to guide relevant future iterations.