What are the Trends of PCI Appropriateness Ratings in Japan?

There was a "significant change" in the inappropriate percutaneous coronary intervention (PCI) rating between the 2009 and 2012 appropriate use criteria (AUC) for coronary revascularization, showing a "needed shift in appropriateness recognition of methods for noninvasive pre-procedural evaluation of coronary artery disease," according to a study published Sept. 15 in JACC: Cardiovascular Interventions.

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The study was led by Taku Inohara, MD, Department of Cardiology, Keio University School of Medicine, Tokyo, who examined 11,258 consecutive PCIs registered in the Japanese Cardiovascular Database. Inohara and colleagues evaluated the appropriateness of PCI indication in Japan based on the AUC, and found that in non-acute settings, 15 percent of PCIs were rated inappropriate under the AUC for coronary revascularization 2009 document, and increased to 30.7 percent under the updated 2012 AUC for coronary revascularization document.

The authors note that the change "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 tensing." They explain that these cases were not rated in the 2009 AUC, thus reflecting in the significant change.

Further, they found that the amount of inappropriate PCIs increased over five years, which was proportional to the increase in coronary computed tomography angiography use, and the use of coronary computed tomography angiography was independently associated with inappropriate PCIs (odds ratio: 1.33; p = 0.027).

Olivia Hung, MD, PhD, writes in a related editorial, "common methods to assess the significance of coronary disease in contemporary Japanese practice are coronary computed tomographic angiography and/or measurement of fractional flow reserve during invasive diagnostic angiography, both of which are being used increasingly often. The AUC are predicated on performing stress tests for determining functionally significant ischemia and not on these alternative technologies." She explains that, "until a larger share of non-acute PCI cases can be classified... the ability of the AUC to inform clinicians (or anyone else) will remain markedly limited."

Keywords: Japan, Odds Ratio, Tomography, Coronary Artery Bypass, Angioplasty, Balloon, Coronary, Exercise Test

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