Development of appropriateness criteria for percutaneous coronary intervention and coronary artery bypass graft surgery using a consensus panel of experts

Takahiro Higashi, Shun Kosaka, Kunihiko Matsui, Sunao Kojima, Hisao Ogawa, Shunichi Fukuhara, Tetsu Yamaguchi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Recent advances in medical devices for ischemic heart disease are expected to expand the indication of percutaneous coronary intervention (PCI). In Japan, however, the number of PCI procedures is already about six times as large as that of coronary artery bypass graft surgery (CABG), which is much larger than western countries where these numbers are about the same, possibly suggesting different criteria of indication in practice. To elucidate the indication criteria used in Japan, we developed a set of appropriateness criteria using the UCLA/RAND Appropriateness Methods. A panel of 9 nationally recognized experts was recruited from all over Japan (7 interventional cardiologists and 2 cardiac surgeons). Based on clinical evidence and professional opinion, they rated the appropriateness of performing PCI and CABG in over 2000 clinical scenarios twice. Between the first and second rating, a face-to-face discussion meeting was held. In contrast to traditional guideline recommendations, some left main diseases were considered to be appropriate for PCI while some single-and two-vessel diseases were inappropriate for CABG. About half of the clinical scenarios had an "indeterminate" agreement level. These findings may explain the higher PCI/CABG ratio in Japan. The area in which no agreement was revealed should be explored in clinical research.

Original languageEnglish
Pages (from-to)34-41
Number of pages8
JournalJapanese Journal of Interventional Cardiology
Volume22
Issue number1
Publication statusPublished - 2007
Externally publishedYes

Fingerprint

Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Japan
Myocardial Ischemia
Guidelines
Equipment and Supplies
Research

Keywords

  • CABG
  • PCI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Development of appropriateness criteria for percutaneous coronary intervention and coronary artery bypass graft surgery using a consensus panel of experts. / Higashi, Takahiro; Kosaka, Shun; Matsui, Kunihiko; Kojima, Sunao; Ogawa, Hisao; Fukuhara, Shunichi; Yamaguchi, Tetsu.

In: Japanese Journal of Interventional Cardiology, Vol. 22, No. 1, 2007, p. 34-41.

Research output: Contribution to journalArticle

Higashi, Takahiro ; Kosaka, Shun ; Matsui, Kunihiko ; Kojima, Sunao ; Ogawa, Hisao ; Fukuhara, Shunichi ; Yamaguchi, Tetsu. / Development of appropriateness criteria for percutaneous coronary intervention and coronary artery bypass graft surgery using a consensus panel of experts. In: Japanese Journal of Interventional Cardiology. 2007 ; Vol. 22, No. 1. pp. 34-41.
@article{2ad5b784e26f418284df918dda27ad7e,
title = "Development of appropriateness criteria for percutaneous coronary intervention and coronary artery bypass graft surgery using a consensus panel of experts",
abstract = "Recent advances in medical devices for ischemic heart disease are expected to expand the indication of percutaneous coronary intervention (PCI). In Japan, however, the number of PCI procedures is already about six times as large as that of coronary artery bypass graft surgery (CABG), which is much larger than western countries where these numbers are about the same, possibly suggesting different criteria of indication in practice. To elucidate the indication criteria used in Japan, we developed a set of appropriateness criteria using the UCLA/RAND Appropriateness Methods. A panel of 9 nationally recognized experts was recruited from all over Japan (7 interventional cardiologists and 2 cardiac surgeons). Based on clinical evidence and professional opinion, they rated the appropriateness of performing PCI and CABG in over 2000 clinical scenarios twice. Between the first and second rating, a face-to-face discussion meeting was held. In contrast to traditional guideline recommendations, some left main diseases were considered to be appropriate for PCI while some single-and two-vessel diseases were inappropriate for CABG. About half of the clinical scenarios had an {"}indeterminate{"} agreement level. These findings may explain the higher PCI/CABG ratio in Japan. The area in which no agreement was revealed should be explored in clinical research.",
keywords = "CABG, PCI",
author = "Takahiro Higashi and Shun Kosaka and Kunihiko Matsui and Sunao Kojima and Hisao Ogawa and Shunichi Fukuhara and Tetsu Yamaguchi",
year = "2007",
language = "English",
volume = "22",
pages = "34--41",
journal = "Japanese Journal of Interventional Cardiology",
issn = "0914-8922",
publisher = "Japanese Society of Interventional Cardiology",
number = "1",

}

TY - JOUR

T1 - Development of appropriateness criteria for percutaneous coronary intervention and coronary artery bypass graft surgery using a consensus panel of experts

AU - Higashi, Takahiro

AU - Kosaka, Shun

AU - Matsui, Kunihiko

AU - Kojima, Sunao

AU - Ogawa, Hisao

AU - Fukuhara, Shunichi

AU - Yamaguchi, Tetsu

PY - 2007

Y1 - 2007

N2 - Recent advances in medical devices for ischemic heart disease are expected to expand the indication of percutaneous coronary intervention (PCI). In Japan, however, the number of PCI procedures is already about six times as large as that of coronary artery bypass graft surgery (CABG), which is much larger than western countries where these numbers are about the same, possibly suggesting different criteria of indication in practice. To elucidate the indication criteria used in Japan, we developed a set of appropriateness criteria using the UCLA/RAND Appropriateness Methods. A panel of 9 nationally recognized experts was recruited from all over Japan (7 interventional cardiologists and 2 cardiac surgeons). Based on clinical evidence and professional opinion, they rated the appropriateness of performing PCI and CABG in over 2000 clinical scenarios twice. Between the first and second rating, a face-to-face discussion meeting was held. In contrast to traditional guideline recommendations, some left main diseases were considered to be appropriate for PCI while some single-and two-vessel diseases were inappropriate for CABG. About half of the clinical scenarios had an "indeterminate" agreement level. These findings may explain the higher PCI/CABG ratio in Japan. The area in which no agreement was revealed should be explored in clinical research.

AB - Recent advances in medical devices for ischemic heart disease are expected to expand the indication of percutaneous coronary intervention (PCI). In Japan, however, the number of PCI procedures is already about six times as large as that of coronary artery bypass graft surgery (CABG), which is much larger than western countries where these numbers are about the same, possibly suggesting different criteria of indication in practice. To elucidate the indication criteria used in Japan, we developed a set of appropriateness criteria using the UCLA/RAND Appropriateness Methods. A panel of 9 nationally recognized experts was recruited from all over Japan (7 interventional cardiologists and 2 cardiac surgeons). Based on clinical evidence and professional opinion, they rated the appropriateness of performing PCI and CABG in over 2000 clinical scenarios twice. Between the first and second rating, a face-to-face discussion meeting was held. In contrast to traditional guideline recommendations, some left main diseases were considered to be appropriate for PCI while some single-and two-vessel diseases were inappropriate for CABG. About half of the clinical scenarios had an "indeterminate" agreement level. These findings may explain the higher PCI/CABG ratio in Japan. The area in which no agreement was revealed should be explored in clinical research.

KW - CABG

KW - PCI

UR - http://www.scopus.com/inward/record.url?scp=33947188119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947188119&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:33947188119

VL - 22

SP - 34

EP - 41

JO - Japanese Journal of Interventional Cardiology

JF - Japanese Journal of Interventional Cardiology

SN - 0914-8922

IS - 1

ER -