Abstract 14727: Rating Discrepancies in Application of Domestic and International Appropriateness Use Criteria; A Report From KICS-Japanese Multicenter PCI Registry
Background: Appropriateness measures for percutaneous coronary intervention (PCI) using Appropriate Use Criteria (AUC) has been in widespread use to assess quality as it relates to patient selection. However, rating discrepancies when assigned on the basis of between international and domestic AUC has not been thoroughly investigated.
Methods: The Japanese Cardiovascular Database (JCD) is a large-scale multicenter PCI registry in Japan established in 2009. JCD was structured in collaboration with the US National Cardiovascular Data Registry (NCDR). We assigned the PCI appropriateness rating for 3912 consecutive non-acute PCI procedures registered in JCD, in which PCIs with the history of coronary artery bypass grafting were excluded. Appropriateness of PCI was assigned on the basis of AUC developed by multiple American professional organizations in 2009 (US-AUC) and by Japanese cardiovascular scientific committee using RAND appropriateness methodology which was originally published in 2007 (J-AUC).
Results: A total of 1899 (48.5%) and 2077 (53.1%) procedures was successfully mapped in US-AUC and J-AUC, respectively. Mapping failure was mainly due to no prior stress test, and no evaluation of ejection fraction. Under US-AUC, 34.9% of PCIs were classified as appropriate, 50.3% as uncertain and 14.8% as inappropriate, whereas 63.2% of procedures were categorized as appropriate, 31.7% as uncertain, and only 5.2% as inappropriate under J-AUC. These rating discrepancies were mainly due to the perception difference for the following scenario; patients with 1- or 2-vessel coronary artery disease and without involving the proximal left anterior descending artery (pLAD). These cases were still categorized as appropriate in J-AUC regardless of their symptomatic status or numbers of antianginal medication when noninvasive tests demonstrated some extent of ischemia.
Conclusion: There were significant and clinically important rating discrepancies between US-AUC and J-AUC based assessment, mostly due to rating of non-pLAD related cases. Further efforts are required to reduce the gap.
- © 2013 by American Heart Association, Inc.