New AHA/ACC Performance, Quality Metrics for Coronary Revascularization

Performance measures are "evidence-based, have exceptions and exclusions supported by evidence and should be actionable," Dehmer added. They typically target meaningful gaps in the quality of care and are based on Class 1 clinical practice guidelines.

Topics addressed in the 15 performance measures include:

  • The importance of using coronary physiological measurements rather than visual assessment of an intermediate severity lesion;.

  • Dual antiplatelet therapy (DAPT) with percutaneous coronary intervention (PCI), as a "cornerstone" of therapy for prevention of thrombotic complications and reduction of ischemic events;

  • Antiplatelets and anticoagulation after PCI, which provide "an important outcome benefit" and represent "an existing gap in care," especially in patients with atrial fibrillation (AF); and

  • P2Y12 inhibitors with fibrinolytic therapy to reduce recurrent ischemia and avoid increased risk of bleeding relative to aspirin.

Other performance measures address aspirin in patients undergoing coronary artery bypass grafting (CABG), lipid management, glycemic control during and after CABG, use of internal mammary artery for CABG, arterial access for PCI, noninfarct artery revascularization in ST-segment elevation myocardial infarction (STEMI), noninfarct artery PCI in STEMI with shock, management of ventricular arrhythmias, and referral to cardiac rehabilitation from inpatient and outpatient settings.

The quality measures emphasize shared decision-making and informed consent; periprocedural hydration in cardiovascular angiography; smoking cessation after revascularization; risk assessment before CABG; and reduction of AF after CABG.

The document also includes two structural measures. One focuses on preprocedural assessment and fostering collaborative efforts among cardiovascular specialists, and the other encourages registry participation to measure performance.