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

Yijie Liu1, Yuxiong Chen1, Zhen'ge Chang2

  • 1Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

Journal of Cardiovascular Development and Disease
|March 28, 2023
PubMed

Insights

The pooled inappropriate percutaneous coronary intervention (PCI) rate is 6.1% worldwide, with higher rates in non-acute cases. This meta-analysis clarifies PCI appropriateness globally.

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.
Abstract

Keywords:
appropriate use criteriaappropriatenesscoronary artery diseasecoronary revascularizationpatient selectionpercutaneous coronary interventions

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