Author + information
- Received April 13, 2020
- Revision received July 16, 2020
- Accepted July 16, 2020
- Published online September 7, 2020.
- Taku Inohara, MD, PhDa,
- Shun Kohsaka, MD, PhDa,∗ (, )@sk2798,
- John A. Spertus, MD, MPHb,
- Frederick A. Masoudi, MD, MSPHc,
- John S. Rumsfeld, MD, PhDc,
- Kevin F. Kennedy, MSb,
- Tracy Y. Wang, MD, MHS, MSd,
- Kyohei Yamaji, MD, PhDa,
- Tetsuya Amano, MD, PhDa and
- Masato Nakamura, MD, PhDa
- aJapanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan
- bSaint Luke’s Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
- cDivision of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- dDuke Clinical Research Institute, Duke University, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Shun Kohsaka, School of Medicine, Keio University, Japanese Association of Cardiovascular Intervention and Therapeutics, Takahashi Building, 9th Floor, 3-2 Kandajinbocho, Chiyoda-ku, Tokyo 101-0051, Japan.
Background Adoption of the results of large-scale randomized controlled trials in percutaneous coronary intervention (PCI) may differ internationally, yet few studies have described the potential variations in PCI practice patterns.
Objectives Using representative national registries, we compared temporal trends in procedural volume, patient characteristics, pre-procedural testing, procedural characteristics, and quality metrics in the United States and Japan.
Methods The National Cardiovascular Data Registry CathPCI was used to describe care in the United States, and the J-PCI was used to assess practice patterns in Japan (numbers of participating hospitals: 1,752 in the United States and 1,108 in Japan). Both registries were summarized between 2013 and 2017.
Results PCI volume increased by 15.8% in the United States from 550,872 in 2013 to 637,650 in 2017, primarily because of an increase in nonelective PCIs (p for trend <0.001). In Japan, the volume of PCIs increased by 36%, from 181,750 in 2013 to 247,274 in 2017, primarily because of an increase in elective PCIs (p for trend <0.001). The proportion of PCI cases for elective conditions was >2-fold greater in Japan (72.7%) than in the United States (33.8%; p < 0.001). Overall, the ratio of nonelective PCI (vs. elective PCI; 27.3% vs. 66.2%; p < 0.001) and the performance of noninvasive stress testing in patients with stable disease (15.2% vs. 55.3%; p < 0.001) was lower in Japan than in the United States. Computed tomography angiography was more commonly used in Japan (22.3% vs. 2.0%; p < 0.001).
Conclusions Elective PCI is more than twice as common in Japan as in the United States in contemporary practice. Computed tomography angiography is much more frequently used pre-procedurally in Japan than in the United States.
This study was funded by the Grant-in-Aid from Scientific Research from the Japan Agency for Medical Research and Development (grant No. 17ek0210097h000) and the Japan Society for the Promotion of Science (grant Nos. 20H03915, 16H05215 and 16KK0186). The J-PCI registry is a registry led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics. Dr. Kohsaka has received investigator-initiated grant funding from Bayer and Daiichi-Sankyo; and has received personal fees from Bayer and Bristol-Myers Squibb. Dr. Spertus owns equity in Health Outcomes Sciences outside the submitted work. Dr. Masoudi has served as chief scientific advisor for the National Cardiovascular Data Registry of the American College of Cardiology. Dr. Amano has received lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi-Sankyo, and Bristol-Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received April 13, 2020.
- Revision received July 16, 2020.
- Accepted July 16, 2020.
- 2020 American College of Cardiology Foundation
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