Appropriateness of Percutaneous Coronary Intervention Performed by Japanese Expert Operators in Patients With Chronic
Tomotsugu Seki1,2, Hironobu Tokumasu3, Hiroyuki Tanaka3
1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University.
Insights
The appropriateness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) was evaluated in a Japanese registry. Approximately 13% of CTO-PCI procedures were deemed "rarely appropriate," indicating a need for improvement.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- The clinical appropriateness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains under-investigated.
- The 2017 appropriate use criteria provide a framework for evaluating PCI appropriateness.
Purpose of the Study:
- To assess the appropriateness of CTO-PCI procedures in a real-world setting using the 2017 appropriate use criteria.
- To analyze trends and identify factors associated with inappropriate CTO-PCI procedures.
- To investigate the association between CTO-PCI appropriateness and in-hospital major adverse cardiovascular and cerebrovascular events (MACCE).
Main Methods:
- Analysis of data from the Japanese CTO-PCI Expert Registry (January 2014 - December 2019).
- Inclusion of consecutive patients undergoing CTO-PCI by highly experienced operators.
- Classification of procedures based on the 2017 appropriate use criteria and logistic regression for MACCE association.
Main Results:
- Out of 5,062 patients, 85.1% lacked evidence of myocardial ischemia via non-invasive stress testing.
- 62.2% of CTO-PCI cases were rated as "may be appropriate," and 12.7% as "rarely appropriate."
- Sensitivity analyses indicated "rarely appropriate" cases ranged from 11.8% to 13.6%.
Conclusions:
- A significant proportion (approximately 13%) of CTO-PCI procedures in this large Japanese registry were classified as "rarely appropriate."
- Substantial efforts are needed to reduce the number of "rarely appropriate" CTO-PCI procedures to optimize patient care and resource utilization.
Background:
The appropriateness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions has rarely been investigated.
Methods And Results:
The Japanese CTO-PCI Expert Registry enrolled consecutive patients undergoing CTO-PCI carried out by highly experienced Japanese CTO specialists who performed more than 50 CTO-PCIs per year and 300 CTO-PCIs in total. This study included patients undergoing CTO-PCI between January 2014 and December 2019. The appropriateness, trends, and differences among the procedures performed by the operators using the 2017 appropriate use criteria were analyzed. Furthermore, we performed a logistic regression analysis to assess whether the appropriateness was associated with in-hospital major adverse cardiovascular and cerebrovascular events (MACCE). Of the 5,062 patients who underwent CTO-PCI, 4,309 (85.1%) patients who did not undergo the non-invasive stress test were classified as having no myocardial ischemia. Of the total cases, 3,150 (62.2%) were rated as "may be appropriate," and 642 (12.7%) as "rarely appropriate" CTO-PCI cases. The sensitivity analyses showed that the number (%) of "may be appropriate" ranged from 4,125 (57.8%) to 4,744 (66.4%) and the number of "rarely appropriate" ranged from 843 (11.8%) to 970 (13.6%) among best and worst scenarios.
Conclusions:
In a large Japanese CTO-PCI registry, approximately 13% of CTO-PCI procedures were classified as "rarely appropriate". Substantial efforts would be required to decrease the number of "rarely appropriate" CTO-PCI procedures.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures