Nevertheless, this has not been done previously in performance measures for procedures. Ideally, this evaluation would revolve around both patients undergo- ing PCI and patients who are deferred from the procedure, to ensure that underutilization of potentially beneficial treatments is not occurring.17 Moreover, the indication (or reason) for the revascularization is attributable to several providers, including the referring physician and interventional cardiologist, as well as their discussions with the consenting patient. To date, the Appropriate Use Criteria for Coronary Revascularization 11 and the ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/ SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization 12 represent the professional societies attempt at providing a framework for evaluating the appropriateness of procedures in the cardiac catheteriza- Prior research demonstrated that the indica- tion for revascularization can be captured and evaluated for appropriateness, although high rates of incomplete data col- lection were noted.19 These criteria propose that emergency or urgent revascularization for patients with acute coronary syndromes is generally considered appropriate. However, for elective revascularization, several important features should Table 4. ACC/AHA Task Force on Performance Measures: Attributes for Performance Measures 1. Evidence Based High-impact area that is useful in improving patient outcomes a) For structural measures, the structure should be closely linked to a meaningful process of care that in turn is linked to a meaningful patient outcome. b) For process measures, the scientific basis for the measure should be well established, and the process should be closely linked to a meaningful patient outcome. c) For outcome measures, the outcome should be clinically meaningful. If appropriate, performance measures based on outcomes should adjust for relevant clinical characteristics through the use of appropriate methodology and high-quality data sources. 2. 