Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Appropriate Use Criteria (AUC) for coronary revascularization aim to optimize percutaneous coronary interventions (PCIs).
• Previous studies showed varied rates of inappropriate (rarely appropriate) PCIs across different populations.
• A comprehensive understanding of the pooled inappropriate PCI rate globally was lacking.

Purpose of the Study:

• To determine the pooled rate of inappropriate percutaneous coronary interventions (PCIs) worldwide.
• To compare inappropriate PCI rates between acute and non-acute scenarios.
• To identify factors influencing inappropriate PCI rates.

Main Methods:

• A systematic literature search was conducted across PubMed, Cochrane, Embase, and Sinomed databases.
• Studies reporting inappropriate/rarely appropriate PCI rates were included in a random effects model meta-analysis.
• Statistical heterogeneity was addressed using a random effects model.

Main Results:

• Thirty-seven studies involving various PCI scenarios were analyzed.
• The pooled inappropriate PCI rate was 4.3% in acute scenarios and 8.9% in non-acute scenarios.
• The overall pooled inappropriate PCI rate was 6.1%, with significantly higher rates in non-acute compared to acute settings.

Conclusions:

• The global rate of inappropriate PCI is substantial, particularly in non-acute situations.
• Inappropriate PCI rates did not significantly differ based on study location, development level, or chronic total occlusion presence.
• Findings underscore the need for adherence to AUC to improve PCI appropriateness.