Appropriateness of Percutaneous Coronary Intervention Performed by Japanese Expert Operators in Patients With Chronic Total Occlusion

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  • Seki Tomotsugu
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
  • Tokumasu Hironobu
    Kurashiki Central Hospital
  • Tanaka Hiroyuki
    Kurashiki Central Hospital
  • Katoh Harumi
    Kurashiki Central Hospital
  • Kawakami Koji
    Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University

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Abstract

<p>Background: The appropriateness of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions has rarely been investigated.</p><p>Methods and Results: The Japanese CTO-PCI Expert Registry enrolled consecutive patients undergoing CTO-PCI carried out by highly experienced Japanese CTO specialists who performed more than 50 CTO-PCIs per year and 300 CTO-PCIs in total. This study included patients undergoing CTO-PCI between January 2014 and December 2019. The appropriateness, trends, and differences among the procedures performed by the operators using the 2017 appropriate use criteria were analyzed. Furthermore, we performed a logistic regression analysis to assess whether the appropriateness was associated with in-hospital major adverse cardiovascular and cerebrovascular events (MACCE). Of the 5,062 patients who underwent CTO-PCI, 4,309 (85.1%) patients who did not undergo the non-invasive stress test were classified as having no myocardial ischemia. Of the total cases, 3,150 (62.2%) were rated as “may be appropriate,” and 642 (12.7%) as “rarely appropriate” CTO-PCI cases. The sensitivity analyses showed that the number (%) of “may be appropriate” ranged from 4,125 (57.8%) to 4,744 (66.4%) and the number of “rarely appropriate” ranged from 843 (11.8%) to 970 (13.6%) among best and worst scenarios.</p><p>Conclusions: In a large Japanese CTO-PCI registry, approximately 13% of CTO-PCI procedures were classified as “rarely appropriate”. Substantial efforts would be required to decrease the number of “rarely appropriate” CTO-PCI procedures.</p>

Journal

  • Circulation Journal

    Circulation Journal 86 (5), 799-807, 2022-04-25

    The Japanese Circulation Society

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