title: Appropriateness of coronary interventions in Japan by the US and Japanese standards.
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.
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Inohara
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kohsaka@cpnet.med.keio.ac.jp.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Ueda
authors.affiliation: Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Noma
authors.affiliation: Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Endo
authors.affiliation: Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Nishi
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.affiliation: Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higashi
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012015:Reference Standards; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D014481:United States
chemical_list: D002317:Cardiovascular Agents