Appropriateness of coronary interventions in Japan by the US and Japanese standards

Taku Inohara, Shun Kosaka, Hiroaki Miyata, Ikuko Ueda, Shigetaka Noma, Masahiro Suzuki, Koji Negishi, Ayaka Endo, Yutaro Nishi, Kentaro Hayashida, Yuichiro Maekawa, Akio Kawamura, Takahiro Higashi, Keiichi Fukuda

Research output: Contribution to journalArticle

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Abstract

Background: Appropriateness use criteria (AUC) are widely used to assess quality of care. American professional organizations and Japanese experts have both developed original AUC for percutaneous coronary intervention (PCI). However, rating discrepancies have not been investigated. Methods: Patients registered in the Japanese multicenter PCI registry were analyzed. We assessed the appropriateness of PCI based on both the US and Japanese criteria and compared the ratings. A logistic regression analysis was performed to identify clinical predictors of inappropriate ratings under both standards. Results: From a total of 4,950 nonacute, consecutive PCIs, 1,982 and 2,077 procedures could be successfully rated using the US and Japanese criteria, respectively. The major difference between the 2 criteria was the rating of "asymptomatic, low- or intermediate-risk patients, no lesion in the proximal left anterior descending coronary artery (PLAD)"; this scenario was deemed appropriate in the Japanese but not in the US criteria. As a consequence, the rate of inappropriate PCI using the Japanese criteria (5.2%) was substantially lower when compared with the rating using the US criteria (15%). Common clinical variables associated with "inappropriate" PCI were male, multivessel diseases, and lesions in the non-PLAD. Suboptimal antianginal medication was also a significant predictor of inappropriate PCI under the US but not under the Japanese criteria. Conclusions: Significant and clinically relevant rating discrepancies were observed between the US and Japanese criteria-based assessments, owing largely to the ratings of asymptomatic, non-PLAD-related, low- or intermediate-risk cases.

Original languageEnglish
Pages (from-to)854-861.e11
JournalAmerican Heart Journal
Volume168
Issue number6
DOIs
Publication statusPublished - 2014 Dec 1

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Percutaneous Coronary Intervention
Japan
Coronary Vessels
Quality of Health Care
Registries
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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Appropriateness of coronary interventions in Japan by the US and Japanese standards. / Inohara, Taku; Kosaka, Shun; Miyata, Hiroaki; Ueda, Ikuko; Noma, Shigetaka; Suzuki, Masahiro; Negishi, Koji; Endo, Ayaka; Nishi, Yutaro; Hayashida, Kentaro; Maekawa, Yuichiro; Kawamura, Akio; Higashi, Takahiro; Fukuda, Keiichi.

In: American Heart Journal, Vol. 168, No. 6, 01.12.2014, p. 854-861.e11.

Research output: Contribution to journalArticle

Inohara, T, Kosaka, S, Miyata, H, Ueda, I, Noma, S, Suzuki, M, Negishi, K, Endo, A, Nishi, Y, Hayashida, K, Maekawa, Y, Kawamura, A, Higashi, T & Fukuda, K 2014, 'Appropriateness of coronary interventions in Japan by the US and Japanese standards', American Heart Journal, vol. 168, no. 6, pp. 854-861.e11. https://doi.org/10.1016/j.ahj.2014.08.011
Inohara, Taku ; Kosaka, Shun ; Miyata, Hiroaki ; Ueda, Ikuko ; Noma, Shigetaka ; Suzuki, Masahiro ; Negishi, Koji ; Endo, Ayaka ; Nishi, Yutaro ; Hayashida, Kentaro ; Maekawa, Yuichiro ; Kawamura, Akio ; Higashi, Takahiro ; Fukuda, Keiichi. / Appropriateness of coronary interventions in Japan by the US and Japanese standards. In: American Heart Journal. 2014 ; Vol. 168, No. 6. pp. 854-861.e11.
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AU - Kosaka, Shun

AU - Miyata, Hiroaki

AU - Ueda, Ikuko

AU - Noma, Shigetaka

AU - Suzuki, Masahiro

AU - Negishi, Koji

AU - Endo, Ayaka

AU - Nishi, Yutaro

AU - Hayashida, Kentaro

AU - Maekawa, Yuichiro

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AU - Higashi, Takahiro

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N2 - Background: Appropriateness use criteria (AUC) are widely used to assess quality of care. American professional organizations and Japanese experts have both developed original AUC for percutaneous coronary intervention (PCI). However, rating discrepancies have not been investigated. Methods: Patients registered in the Japanese multicenter PCI registry were analyzed. We assessed the appropriateness of PCI based on both the US and Japanese criteria and compared the ratings. A logistic regression analysis was performed to identify clinical predictors of inappropriate ratings under both standards. Results: From a total of 4,950 nonacute, consecutive PCIs, 1,982 and 2,077 procedures could be successfully rated using the US and Japanese criteria, respectively. The major difference between the 2 criteria was the rating of "asymptomatic, low- or intermediate-risk patients, no lesion in the proximal left anterior descending coronary artery (PLAD)"; this scenario was deemed appropriate in the Japanese but not in the US criteria. As a consequence, the rate of inappropriate PCI using the Japanese criteria (5.2%) was substantially lower when compared with the rating using the US criteria (15%). Common clinical variables associated with "inappropriate" PCI were male, multivessel diseases, and lesions in the non-PLAD. Suboptimal antianginal medication was also a significant predictor of inappropriate PCI under the US but not under the Japanese criteria. Conclusions: Significant and clinically relevant rating discrepancies were observed between the US and Japanese criteria-based assessments, owing largely to the ratings of asymptomatic, non-PLAD-related, low- or intermediate-risk cases.

AB - Background: Appropriateness use criteria (AUC) are widely used to assess quality of care. American professional organizations and Japanese experts have both developed original AUC for percutaneous coronary intervention (PCI). However, rating discrepancies have not been investigated. Methods: Patients registered in the Japanese multicenter PCI registry were analyzed. We assessed the appropriateness of PCI based on both the US and Japanese criteria and compared the ratings. A logistic regression analysis was performed to identify clinical predictors of inappropriate ratings under both standards. Results: From a total of 4,950 nonacute, consecutive PCIs, 1,982 and 2,077 procedures could be successfully rated using the US and Japanese criteria, respectively. The major difference between the 2 criteria was the rating of "asymptomatic, low- or intermediate-risk patients, no lesion in the proximal left anterior descending coronary artery (PLAD)"; this scenario was deemed appropriate in the Japanese but not in the US criteria. As a consequence, the rate of inappropriate PCI using the Japanese criteria (5.2%) was substantially lower when compared with the rating using the US criteria (15%). Common clinical variables associated with "inappropriate" PCI were male, multivessel diseases, and lesions in the non-PLAD. Suboptimal antianginal medication was also a significant predictor of inappropriate PCI under the US but not under the Japanese criteria. Conclusions: Significant and clinically relevant rating discrepancies were observed between the US and Japanese criteria-based assessments, owing largely to the ratings of asymptomatic, non-PLAD-related, low- or intermediate-risk cases.

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