Diagnosis: Recurrent angina Issue under review: Inpatient admission Determination: The inpatient admission was medically necessary. The patient presented for management of recurrent angina, and was noted to have obstructive disease of the RCA on cardiac catheterization. A coronary intervention with stent placement was performed on a CTO (chronic total occlusion), with use of dual injection and rotational atherectomy, which is considered a complex PCI. In addition the patient's course was complicated by a post-procedure myocardial infarction. Patients such as this one were excluded from the studies of outpatient PCI. It would be consistent with the current standard of care that this patient, after this complex PCI with the use of rotational atherectomy, be managed in an inpatient setting. Therefore, the requested inpatient admission was medically appropriate in this clinical setting.

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