The Appropriateness of PCI by Japanese Specialists in Patients with CTO: The Japanese CTO-PCI Expert Registry

The Japanese CTO-PCI expert registry shows that approximately 13% of CTO-PCIs are classified as “rarely appropriate,” and that considerable efforts are needed to reduce this number, as reported by Dr. Tomotsugu Seki and his colleagues of the Kyoto Prefectural University of Medicine in the May issue of Circulation Journal.

The registry includes successive CTO-PCI patients whose operations were performed by Japanese CTO specialists with experience of more than 50 CTO-PCIs per year for a total of more than 300 CTO-PCIs.

Patients who underwent CTO-PCI from January 2014 to December 2019 were included in this study; we analyzed the suitability, trends, and differences in procedures performed by operators using the 2017 Appropriate Use Criteria. In addition, logistic regression analysis was performed to assess whether appropriateness was associated with in-hospital MACCE.

Of the 5,062 patients who underwent CTO-PCI, 4,309 (85.1%) who did not undergo noninvasive stress testing were classified as having no myocardial ischemia. Of all cases, 3,150 (62.2%) were CTO-PCI cases rated as “may be appropriate” and 642 (12.7%) as “rarely appropriate.” Sensitivity analysis showed that the number (%) of “may be appropriate” cases ranged from 4,125 (57.8%) to 4,744 (66.4%) and the number of “rarely appropriate” cases ranged from 843 (11.8%) to 970 (13.6%) for the best and worst scenarios.

Dr. Seki et al. summarized, “In this study, approximately 13% of CTO-PCIs were rated as “rarely appropriate,” but the results should be interpreted with caution because information on noninvasive stress testing was not available for a large number of patients. Further efforts should be made to collect more detailed data and reduce the number of “rarely appropriate” cases in routine practice.”

Seki T, et al. Circ J. 2022; 86: 799-807

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