Appendix C. Detail on criteria for audit of the use of coronary artery stents

Possible objectives for an audit

An audit could be carried out to ensure that stents are being used appropriately in patients undergoing PCIs. Local clinical audits could also confirm that PCI is the clinically appropriate procedure for patients included in the audit.

Possible patients to be included in the audit

An audit could include all patients having a PCI for stable or unstable angina, acute MI or symptomatic CAD in a suitable time period, for example, 3 months.

Measures that could be used as a basis for audit

The measures that could be used in an audit of stents are as follows.

Criterion

Standard

Exception

Definition of terms

1. Stents are used when a PCI is performed in an individual having any of the following:

a. stable angina or

b. unstable angina or

c. acute MI

100% of individuals having a PCI for stable or unstable angina or acute MI

None

Clinicians will need to agree locally on any exceptions for audit purposes.

2. A Cypher or a Taxus stent is used in a PCI for an individual with symptomatic CAD when either of the following occurs:

a. the target artery is < 3mm in calibre or

b. the lesion to be stented is longer than 15 mm

100% of individuals having a PCI for symptomatic CAD

A. The individual has had an MI in the preceding 24 hours

B. The individual has angiographic evidence of thrombus in the target artery

Clinicians will need to agree locally on any other exceptions for audit purposes.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

x 100

Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.