Appropriateness ratings of percutaneous coronary intervention in Japan and its association with the trend of noninvasive testing

Taku Inohara, Shun Kosaka, Hiroaki Miyata, Ikuko Ueda, Shiro Ishikawa, Takahiro Ohki, Yutaro Nishi, Kentaro Hayashida, Yuichiro Maekawa, Akio Kawamura, Takahiro Higashi, Keiichi Fukuda

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1000-1009
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume7
Issue number9
DOIs
Publication statusPublished - 2014 Sep 1

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Percutaneous Coronary Intervention
Area Under Curve
Japan
Quality of Health Care
Quality Improvement
Registries
Coronary Artery Disease
Logistic Models
Odds Ratio
Databases
Computed Tomography Angiography

Keywords

  • appropriateness use criteria
  • percutaneous coronary intervention
  • quality of care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Appropriateness ratings of percutaneous coronary intervention in Japan and its association with the trend of noninvasive testing. / Inohara, Taku; Kosaka, Shun; Miyata, Hiroaki; Ueda, Ikuko; Ishikawa, Shiro; Ohki, Takahiro; Nishi, Yutaro; Hayashida, Kentaro; Maekawa, Yuichiro; Kawamura, Akio; Higashi, Takahiro; Fukuda, Keiichi.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 9, 01.09.2014, p. 1000-1009.

Research output: Contribution to journalArticle

Inohara, Taku ; Kosaka, Shun ; Miyata, Hiroaki ; Ueda, Ikuko ; Ishikawa, Shiro ; Ohki, Takahiro ; Nishi, Yutaro ; Hayashida, Kentaro ; Maekawa, Yuichiro ; Kawamura, Akio ; Higashi, Takahiro ; Fukuda, Keiichi. / Appropriateness ratings of percutaneous coronary intervention in Japan and its association with the trend of noninvasive testing. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 9. pp. 1000-1009.
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abstract = "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.",
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T1 - Appropriateness ratings of percutaneous coronary intervention in Japan and its association with the trend of noninvasive testing

AU - Inohara, Taku

AU - Kosaka, Shun

AU - Miyata, Hiroaki

AU - Ueda, Ikuko

AU - Ishikawa, Shiro

AU - Ohki, Takahiro

AU - Nishi, Yutaro

AU - Hayashida, Kentaro

AU - Maekawa, Yuichiro

AU - Kawamura, Akio

AU - Higashi, Takahiro

AU - Fukuda, Keiichi

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N2 - 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.

AB - 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.

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