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(Circulation. 2005;112:2754-2755.)
© 2005 American Heart Association, Inc.

Editorial

Guidelines, Lighthouses, and a Toe in the Water

David R. Holmes, Jr, MD; Patricia Hodgson, BA; Mandeep Singh, MD

From Mayo Clinic (D.R.H., M.S.), Rochester, Minn, and Duke Clinical Research Institute (P.H.), Durham, NC.

Correspondence to Mandeep Singh, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Key Words: Editorials • coronary disease • risk factors • guidelines

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
A guideline tells you how to get someplace, whereas a lighthouse keeps you off the rocks; both can shepherd you on a safe journey toward your goal. The American College of Cardiology (ACC), in concert with the American Heart Association (AHA), has been at the forefront of developing guidelines for percutaneous coronary interventions (PCI).¹ In an era in which there are multiple data sets to draw from, guidelines help to sort out optimal from less optimal evidence-based approaches. Application of these guidelines makes intuitive sense as we counsel our individual patients about the risk/benefit ratio of PCI and as we develop treatment strategies for healthcare delivery systems to employ.

Article p 2786

Although the guidelines approach makes intuitive sense, there are very limited data about the impact guidelines have had on PCI. The current article by Anderson et al² is a substantial effort to remedy that shortfall. As the authors point out, the ACC’s National Cardiovascular Data Registry (ACC-NCDR) was developed to apply rigorous methodology to the collection of data about interventional procedures using uniform data entry, written definitions, and data quality checks. It has become a robust tool and, in the present study, provides the results of 463 088 procedures performed from January 1, 2001, to March 31, 2004. Given the large size of the data set, important statistical and clinically meaningful conclusions could be expected, and in fact, some were identified.

	What Did We Learn?

 
The majority of non-STEMI procedures are performed for either class I ("evidence and/or general agreement that the . . . [Full Text of this Article]