First, the writing committee considered the key initial question of whether performing the proce- dure was appropriate, in line with a growing body of evidence in this area. Determining procedural appropri- ateness of PCI is complex and requires comprehensive documentation of the procedure s priority, the presence and severity of angina symptoms, the use of antianginal medical therapies, and the presence and severity of stenosis (as documented by angiography or other metrics of lesion severity, e.g., intravascular ultrasound or fractional ow reserve). The present PCI performance measure set rep- resents the rst time in the cardiology literature that a speci c performance measure has been constructed to address procedural appropriateness. Next, the writing committee listed important tasks to be done by the care team before the procedure, including determining whether the patient can and would be likely to take dual-antiplatelet therapy on an ongoing basis (an important requirement if drug-eluting stents are to be used), as well as documenting the patient s renal function (which can in uence both the patient s candidacy for the procedure and procedural strategiesde.g., amount of iodinated contrast). Many procedural and postprocedural factors that can affect patient outcomes are considered in this measure set, such as the use of embolic protection devices and the documentation of ionized radiation and iodinated contrast dosage. The writing committee also put the procedure in the context of patients longitudinal disease process. Specif- ically, they considered that procedural quality must extend beyond the laboratory and should involve implementation of appropriate secondary prevention cardiac rehabilitation and medications to modify long-term risk. Finally, the writing committee considered other indicators of quality related to the interventionalist and the institution. 