The manner in which these issues are addressed is dependent on several factors, including the measure design, data collection method, performance attribution, baseline perfor- mance rates, reporting methods, and incentives linked to these reports. These implementation challenges are appropriately dis- cussed in individual sections dedicated to each of the measures. These new performance measures for PCI are notable for sev- eralreasons.First,thewritingcommitteeconsideredthekeyinitial question of whether performing the procedure was appropriate, in line with a growing body of evidence in this area. Determining procedural appropriateness of PCI is complex and requires com- prehensive documentation of the procedure s priority, the pres- ence 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 sever- ity, eg, intravascular ultrasound or fractional flow reserve). The present PCI performance measure set represents the first time in the cardiology literature that a specific 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 deter- mining 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 influ- ence both the patient s candidacy for the procedure and pro- cedural strategies eg, 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 ion- ized radiation and iodinated contrast dosage. The writing committee also put the procedure in the context of patients longitudinal disease process. 