Taku Inohara1, Shun Kohsaka2, Hiroaki Miyata3, Ikuko Ueda1, Shigetaka Noma4, Masahiro Suzuki5, Koji Negishi6, Ayaka Endo7, Yutaro Nishi8, Kentaro Hayashida1, Yuichiro Maekawa1, Akio Kawamura1, Takahiro Higashi9, Keiichi Fukuda1. 1. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 2. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kohsaka@cpnet.med.keio.ac.jp. 3. Department Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan. 4. Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan. 5. Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan. 6. Department of Cardiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 7. Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan. 8. Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan. 9. Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
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.
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.
Authors: Yuliya V Popova; Anton R Kiselev; Olesya V Sagaydak; Olga M Posnenkova; Vladimir I Gridnev; Elena V Oshchepkova Journal: Eurasian J Med Date: 2021-06
Authors: Taku Inohara; Shun Kohsaka; Hiroaki Miyata; Mitsuaki Sawano; Ikuko Ueda; Yuichiro Maekawa; Keiichi Fukuda; Philip G Jones; David J Cohen; Zhenxiang Zhao; John A Spertus; Kim G Smolderen Journal: J Am Heart Assoc Date: 2017-10-27 Impact factor: 5.501
Authors: Yuan Lu; Haibo Zhang; Yongfei Wang; Tianna Zhou; John Welsh; Jiamin Liu; Wenchi Guan; Jing Li; Xi Li; Xin Zheng; John A Spertus; Frederick A Masoudi; Harlan M Krumholz; Lixin Jiang Journal: JAMA Netw Open Date: 2018-12-07