Left Atrial Appendage Closure Guided by Personalized 3D-Printed Cardiac Reconstruction.

analysis must include, not only those who undergo the procedure, but also those in whom the procedure was deferred. In 2012, Joynt et al. attempted to answer this question by exploring the outcomes of all patients with myocardial infarction in states that adopted public reporting, compared with those that did not. They found that in states with public reporting, mortality rates were significantly higher for patients presenting with ST-segment elevation myocardial infarction (p 1⁄4 0.004) with a trend toward worse outcomes for the larger cohort of all patients with myocardial infarction (p 1⁄4 0.10). More recently, this same approach was applied to a much larger population, revealing a dramatic 21% increase in mortality for patients presenting with myocardial infarction in states with public reporting (p 1⁄4 0.013) (5). This was driven primarily by an increase in mortality in patients in whom intervention was deferred. With these results, we must conclude that public reporting of procedural outcomes results in public harm. We applaud Sherwood et al. (1) for their efforts. At the same time, we wonder whether the time has come to move away from procedure-based risk scores and toward diagnosis-based databases that examine the outcomes of all patients, not just those subgroups selected to undergo specific procedures.