Patients arriving from the inpatient setting or emer- gency department and those with acute coronary syndromes were considered secondarily. The writing committee decided on this approach for 2 reasons. First, in patients with acute coronary syndromes, abundant data indicate that revascular- ization with PCI is beneficial, and prior measure sets focused on this disease condition have included measures targeting these patients (eg, door-to-balloon time in ST-elevation myocardial infarction). Second, in selected patients under- going elective procedures, such as those with chronic stable angina, there is greater controversy as to the best therapy that should be used. Patients referred to the cardiac catheteriza- tion laboratory in these settings usually have stable angina that is no longer controlled with medications or have high- risk findings on a noninvasive stress test. The benefit of PCI in these patients is primarily symptom reduction, and data on a mortality rate benefit for this group are limited.14 16 3.2. Avoiding Overlap and Ensuring Alignment With Existing Measure Sets and Guidelines The writing committee made every effort to avoid overlap with existing measure sets and to harmonize these performance measures with other ACC/AHA/AMA-PCPI performance measure sets when possible. For example, the writing com- mittee did not explore door-to-balloon time as a performance measure, given that this would overlap with performance mea- sures for acute myocardial infarction already constructed and endorsed by numerous organizations. An example of harmo- nization within the measure set is the postprocedural optimal medical therapy composite measure in the present document, which is aligned with the similar National Quality Forum endorsed ACCF facility-level measure. Table 3. 