Abstract 18511: Appropriateness of Coronary Interventions for Chronic Total Occlusion in Japan based on the U.S. Appropriateness Use Criteria
Introduction: Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is widely performed in Japan, despite its technical difficulty, perceived risk of complications, and, most of all, insufficient evidence-based validation. We sought to assess its appropriateness on the basis of the appropriateness use criteria (AUC) developed by multiple American professional organizations in 2012.
Methods: Japanese Cardiovascular Database (JCD-KICS) is a large-scale multicenter PCI registry in Japan established in 2009, and is structured in collaboration with the NCDR®. We assigned an appropriateness rating to 4950 consecutive PCIs for non-acute indications registered in JCD-KICS according to the AUC. The current appropriateness criteria contain 5 CTO related scenarios (#24-29). The ratings were compared between the PCIs for lesions with and without CTO.
Results: Mapping failures were identified in 2521 procedures, and were mainly due to the PCIs without performing the prior stress test (n=934) and staged PCIs (n=750). Among 2429 successfully mapped PCIs, a total of 213 (8.8%) PCIs for CTO were identified. CTO cases had higher rates of multi-vessel diseases (16.4% vs. 10.9%, p=0.039), and were more frequently evaluated with coronary computed tomography angiography (42.7% vs. 31.5%, p=0.001). Only 16.9% of CTO cases were successfully assigned to CTO related scenarios, and other cases were mapped to non-CTO related scenarios. Overall, the rate of inappropriate indications was lower in PCIs for lesion with CTO than those without (22.5% vs 31.5%, p=0.006).
Conclusions: In contemporary multicenter Japanese PCI registry, as much as one-tenth of non-acute PCIs were attempted on CTO lesion. Despite the common belief that CTO related PCIs are performed under insufficient evidence, most of these procedures were performed under appropriate indications. However, further revision of AUC with additional CTO related scenarios are necessary for its rigorous evaluation.
Author Disclosures: T. Inohara: None. S. Kohsaka: None. H. Miyata: None. I. Ueda: None. K. Hayashida: None. Y. Maekawa: None. A. Kawamura: None. K. Fukuda: None.
- © 2014 by American Heart Association, Inc.