Abstract 14818: Appropriateness of Percutaneous Coronary Intervention in Japan; International Application of 2009 and 2012 ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT Appropriateness Use Criteria
Background: Appropriate Use Criteria (AUC) for Coronary Revascularization has been used widely to assess the quality of percutaneous coronary intervention (PCI). However, reports on its international application have been sparse. We sought to evaluate the appropriateness of PCI indications in Japan.
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 10788 consecutive PCI procedures registered in JCD. Appropriateness of PCI was assigned on the basis of AUC developed by multiple American professional organizations in 2009 (US-AUC/2009) and 2012 (US-AUC/2012).
Results: A total of 5977 (55.4%) procedures was successfully mapped. Mapping failure was mainly due to unstable angina without high-risk features (n=1105, 23.0%), non-acute PCI procedures without performing stress test (n=935, 19.4%), and staged PCI procedures (n=748, 15.5%). Among acute PCIs [3995 patients successfully mapped], majority of PCI indications (96.3%) was rated appropriate, whereas in the non-acute PCIs [1982 patients successfully mapped], 15.0% of PCIs was rated inappropriate under US-AUC/2009. Inappropriate PCIs were more likely to be performed for patients with  no symptoms,  suboptimal medical therapy, or  no lesion in the proximal left anterior descending (LAD) coronary artery. When appropriateness was evaluated under more recent international criteria (US-AUC/2012), the rate of inappropriate PCI in non-acute settings increased substantially (30.7%). This increase was mainly explained by the decision on the scenario of  asymptomatic patients with 1- or 2-vessel coronary artery disease,  no proximal LAD involvement, and  no prior noninvasive testing performed.
Conclusion: In contemporary multicenter Japanese PCI registry, about one-sixth of non-acute PCI was rated as inappropriate based on the international standards, and even higher rate under the revised, more recent criteria. These indications could be the potential targets for improving quality of care in PCI.
- © 2013 by American Heart Association, Inc.