Appropriateness of Percutaneous Coronary Intervention Performed by Japanese Expert Operators in Patients With Chronic Total Occlusion
Appropriateness of Percutaneous Coronary Intervention Performed by Japanese Expert Operators in Patients With Chronic Total Occlusion
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DOI：
10.1253/circj.cj-21-0483
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发表时间：
2022-05-01
影响因子：
3.3
通讯作者：
Kawakami, Koji
中科院分区：
文献类型：
--
作者：
Seki, Tomotsugu;Tokumasu, Hironobu;Kawakami, Koji
背景：很少研究经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）病变的适当性。方法和结果：日本CTO-PCI专家登记研究招募了接受CTO-PCI的连续患者，这些患者由经验丰富的日本CTO专家进行，他们每年进行50多次CTO-PCI，总计300次CTO-PCI。本研究纳入了2014年1月至2019年12月期间接受CTO-PCI的患者。分析了操作员使用2017年适当使用标准执行的程序的适当性、趋势和差异。此外，我们进行了逻辑回归分析，以评估是否适当与院内主要不良心血管和脑血管事件（MACCE）。在接受CTO-PCI的5，062例患者中，4，309例（85.1%）未接受无创负荷试验的患者被归类为无心肌缺血。在所有病例中，3，150例（62.2%）被评定为“可能适当”，642例（12.7%）被评定为“很少适当”的CTO-PCI病例。敏感度分析显示，在最佳和最差情况下，“可能适当”的数量（%）范围为4，125（57. 8%）至4，744（66. 4%），“很少适当”的数量范围为843（11. 8%）至970（13. 6%）。结论：在一项大型日本CTO-PCI登记研究中，约13%的CTO-PCI手术被归类为“很少适用”。将需要大量的努力来减少“很少适当”的CTO-PCI手术的数量。
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.