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Discussion| In a national registry of patients undergoing nonacute PCI, we found that approximately 1 in 6 patients were asymptomatic at the time of PCI. If the AUC were modified to incorporate randomized clinical trials, such as COURAGE5 and the recent ISCHEMIA trial, 2 and considered these PCIs to be rarely appropriate for SIHD, the rates of rarely appropriate PCI may be nearly 7-fold higher compared with current AUC ratings. Given that we were unable to assess whether optimal antianginal therapy had failed before PCI in the current or modified AUC, the proportion of patients with PCIs classified as rarely appropriate with either AUC could be even higher than we estimate. As PCIs in patients with SIHD are estimated to cost $2.8 billion annually6 and are associated with risks for bleeding, infection, and death, these findings underscore the importance of updating clinical guidelines and AUC to be consistent …