Quality of Care and Outcomes of Care of Percutaneous Coronary Interventions in Ontario

Abstract

BACKGROUND: Percutaneous coronary intervention (PCI) is the most commonly performed procedure for treating coronary artery disease (CAD), however, relatively little is known regarding the quality of PCI in Canada. We have previously assembled a panel of cardiovascular experts to develop a set of quality indicators that is suitable for implementation in the Canadian health care system. In this study, we evaluated the quality of care of PCI in Ontario by measuring the adherence of established PCI quality indicators in routine clinical practice. METHODS: A chart abstraction study was conducted at hospitals with the capability to perform PCI in Ontario, Canada from 2009 and 2010. A target study sample of approximately 200 PCI procedures were taken from each site in order to obtain a representative sample of patients with stable coronary artery disease (CAD) and acute coronary syndrome (ACS). Process indicators assessed included prescription of aspirin, dual anti-platelet therapy, statins, smoking cessation, and others. Outcome indicators included death, myocardial infarction, and other adverse PCI complications. RESULTS: Our study sample included 3,041 patients, of which 18% had stable CAD and 82% had an ACS. Their mean age was 63 AE 12.4 years and 29% of the patients were female. Among them, 89% were prescribed aspirin prior to PCI, 98.7% were prescribed aspirin after PCI, 95.1% were prescribed dual antiplatelet therapy for 12 months after drug eluting stents, and 94.9% were prescribed statins. The lowest performing quality indicator was smoking cessation counseling, which was observed in 42% of patients (18% in stable CAD and 47% in ACS; p<0.001). PCI outcomes stratified by stable CAD vs ACS are shown in Table 1. CONCLUSION: This current study demonstrates high levels of adherence to quality indicators and relatively low rates of adverse events for patients undergoing PCI procedures in Ontario.Smoking cessation counseling was not consistently performed and could represent a focus for future quality improvement efforts.