Without existing data on its use in test populations, however, it is difficult to know whether the current measure accurately cap- tures appropriateness (as opposed to encouraging gaming) or whether it will lead to unintended consequences by discourag- ing operators from taking on difficult or high-risk procedures where, although the risk is high, the benefit could be great (ie, whether the measure will promote underuse). Concern for this last issue is evident in the evolving processes of the AUC, which have undergone significant changes since their early iterations (see below). For these reasons, we designated this measure for internal quality improvement only (see Appendix C for a summary of the writing committee s evaluation). The writing committee also considered addressing the inap- propriate indications for elective PCI, as this has been one of the most important features of the AUC. However, the AUC docu- ments specifically underscore the pivotal role of clinical judg- ment in determining whether revascularization is indicated for an individual patient. The rating of a revascularization as inap- propriate by any schematic should not preclude a provider from performing PCI when patient- and condition-specific data sup- Thisisreflectedinnewlanguage; inappro- priate has been changed to rarely appropriate. Nevertheless, documentation of the reasons for performing a PCI should still be mandatory. Because the criteria for appropriate indications for elective PCI appear to be, in general, less prone to various interpretations, the writing committee decided to focus on appro- priate procedures at the present time. It is certainly possible that measurement of rarely appropriate indications for elective PCI might become part of future performance measures. 5.3. Assessment of Candidacy for Dual-Antiplatelet Therapy Dual-antiplatelet therapy is integral to preventing stent thrombo- sis in patients treated with stents during PCI. 