Appropriateness Ratings of Percutaneous Coronary Intervention in Japan and Its Association With the Trend of Noninvasive Testing
Appropriateness Ratings of Percutaneous Coronary Intervention in Japan and Its Association With the Trend of Noninvasive Testing
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DOI：
10.1016/j.jcin.2014.06.006
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发表时间：
2014-09-01
影响因子：
11.3
通讯作者：
Fukuda, Keiichi
中科院分区：
文献类型：
--
作者：
Inohara, Taku;Kohsaka, Shun;Fukuda, Keiichi
目的：本研究的目的是评估日本经皮冠状动脉介入治疗（PCI）的适宜性，并阐明术前无创检查趋势与适宜性评分变化之间的关系。虽然PCI适宜性标准被广泛用于改善护理质量，但尚未在国际上得到验证。此外，适当性评分与实施新开发的无创检测的相关性尚不清楚。方法：根据2009年制定的适宜性使用标准（AUC/2009）和2012年修订版本（AUC/2012），我们对在日本心血管数据库中连续注册的11,258名pci进行适宜性评分。绘制手术前无创检查趋势和适宜性评分；采用逻辑回归来识别不合适的PCI预测因子。结果在非急性情况下，15%的pci在AUC/2009标准下被评为不合适，而在AUC/2012标准下这一比例增加到30.7%。这主要是因为AUC的重点更新，如果患者缺乏近端左前降病变且未进行术前无创检查，则将其新分类为不合适。然而，这些案例根本没有被列入AUC/2009。不适当pci的数量在5年内增加，与冠状动脉ct血管造影使用的增加成正比。冠状动脉ct血管造影的使用与不适当的pci独立相关（优势比：1.33;p = 0.027）。结论：在多中心的日本PCI登记中，根据AUC/2009，约六分之一的非急性PCI被评为不合适，根据修订的AUC/2012，这一比例增加到约三分之一。这一重大差距可能反映了对冠状动脉疾病无创术前评估方法的适当性认识的必要转变。(C) 2014年由美国心脏病学会基金会发布。
OBJECTIVES The aim of this study was to evaluate the appropriateness of percutaneous coronary intervention (PCI) in Japan and clarify the association between trends of pre-procedural noninvasive testing and changes in appropriateness ratings.BACKGROUND Although PCI appropriateness criteria are widely used for quality-of-care improvement, they have not been validated internationally. Furthermore, the correlation of appropriateness ratings with implementation of newly developed noninvasive testing is unclear.METHODS We assigned an appropriateness rating to 11,258 consecutive PCIs registered in the Japanese Cardiovascular Database according to appropriateness use criteria developed in 2009 (AUC/2009) and the 2012 revised version (AUC/2012). Trends of pre-procedural noninvasive testing and appropriateness ratings were plotted; logistic regression was performed to identify inappropriate PCI predictors.RESULTS In nonacute settings, 15% of PCIs were rated inappropriate under AUC/2009, and this percent increased to 30.7% under AUC/2012 criteria. This was mostly because of the focused update of AUC, in which the patients were newly classified as inappropriate if they lacked proximal left anterior descending lesions and did not undergo pre-procedural noninvasive testing. However, these cases were simply not rated under AUC/2009. The amount of inappropriate PCIs increased over 5 years, proportional to the increase in coronary computed tomography angiography use. Use of coronary computed tomography angiography was independently associated with inappropriate PCIs (odds ratio: 1.33; p = 0.027).CONCLUSIONS In a multicenter, Japanese PCI registry, approximately one-sixth of nonacute PCIs were rated as inappropriate under AUC/2009, increasing to approximately one-third under the revised AUC/2012. This significant gap may reflect a needed shift in appropriateness recognition of methods for noninvasive pre-procedural evaluation of coronary artery disease. (C) 2014 by the American College of Cardiology Foundation.