Clinical Outcomes Associated with Appropriate Use of Percutaneouscoronary Intervention

Najmi Fauzan Tarsidin; Panji Fortuna Hadisoemarto; Noormarina Indraswari; Lusiana Siti Masytoh; Badai Bhatara Tiksnadi

doi:10.70716/mohr.v4i3.580

Authors

Najmi Fauzan Tarsidin Center for Health Technology Assessment, Universitas Padjadjaran, Indonesia
Panji Fortuna Hadisoemarto Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Indonesia
Noormarina Indraswari Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Indonesia
Lusiana Siti Masytoh Health Technology Assessment Committee, Ministry of Health of the Republic of Indonesia, Indonesia
Badai Bhatara Tiksnadi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Indonesia

DOI:

https://doi.org/10.70716/mohr.v4i3.580

Keywords:

Appropriateness criteria, AUC, Percutaneous coronary intervention, PCI, Clinical outcomes

Abstract

The Appropriate Use Criteria (AUC), developed by the American College of Cardiology Foundation, serve as a guideline to optimize patient selection for percutaneous coronary intervention (PCI); however, their association with clinical outcomes remains unclear. This systematic review examines the relationship between AUC classification and clinical outcomes in patients undergoing PCI for stable ischemic heart disease and acute coronary syndrome, based on publications retrieved from The Cochrane Library, EMBASE, and MEDLINE from January 2009 to October 2024, including studies utilizing the 2009 and 2012 AUC versions as well as a country-specific adaptation. Five studies comprising 55,687 patients met the inclusion criteria. Two studies assessed short-term and in-hospital clinical outcomes; one reported a higher incidence of major adverse cardiovascular events (MACE) among patients receiving inappropriate PCI. At the same time, the other found no significant impact of AUC classification on short-term outcomes. Regarding long-term outcomes, three out of four studies found no significant association between AUC classification and long-term clinical outcomes. Taken together, the available evidence remains limited and inconsistent, underscoring the need to refine the AUC framework further to ensure a more evidence-based approach to guiding patient selection and improving outcomes among patients undergoing PCI.

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References

Ahn, J. M., Kang, D. Y., Lee, P. H., Ahn, Y. K., Kim, W. J., Nam, C. W., Jeong, J. O., Chae, I. H., Shiomi, H., Kao, P. H. L., Hahn, J. Y., Her, S. H., Lee, B. K., Ahn, T. H., Chang, K., Chae, J. K., Smyth, D., Stone, G. W., Park, D. W., & Park, S. J. (2023). Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque: Rationale and design of the randomized, controlled PREVENT trial. American Heart Journal, 264(10), 83–96. https://doi.org/10.1016/j.ahj.2023.05.017

Banning, A. P., Serruys, P., De Maria, G. L., Ryan, N., Walsh, S., Gonzalo, N., Jan van Geuns, R., Onuma, Y., Sabate, M., Davies, J., Lesiak, M., Moreno, R., Cruz-Gonzalez, I., Hoole, S. P., Piek, J. J., Appleby, C., Fath-Ordoubadi, F., Zaman, A., Van Mieghem, N. M., … Escaned, J. (2022). Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: final results of the SYNTAX II study. European Heart Journal, 43(13), 1307–1316. https://doi.org/10.1093/eurheartj/ehab703

Barbash, I. M., Dvir, D., Torguson, R., Xue, Z., Satler, L. F., Pichard, A. D., & Waksman, R. (2013). Prognostic implications of percutaneous coronary interventions performed according to the appropriate use criteria for coronary revascularization. Cardiovascular Revascularization Medicine, 14(6), 316–320. https://doi.org/10.1016/j.carrev.2013.07.008

Bradley, S. M., Chan, P. S., Hartigan, P. M., Nallamothu, B. K., Weintraub, W. S., Sedlis, S. P., Dada, M., Maron, D. J., Kostuk, W. J., Berman, D. S., Teo, K. K., Mancini, G. B. J., Boden, W. E., & Spertus, J. A. (2015). Validation of the Appropriate Use Criteria for Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease (from the COURAGE Trial). The American Journal of Cardiology, 116(2), 167–173. https://doi.org/10.1016/j.amjcard.2015.03.057

Byrne, R. A., Fremes, S., Capodanno, D., Czerny, M., Doenst, T., Emberson, J. R., Falk, V., Gaudino, M., McMurray, J. J. V, Mehran, R., Milojevic, M., & Sousa Uva, M. (2023). 2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG. European Heart Journal, 44(41), 4310–4320. https://doi.org/10.1093/eurheartj/ehad476

Chacko, L., P. Howard, J., Rajkumar, C., Nowbar, A. N., Kane, C., Mahdi, D., Foley, M., Shun-Shin, M., Cole, G., Sen, S., Al-Lamee, R., Francis, D. P., & Ahmad, Y. (2020). Effects of Percutaneous Coronary Intervention on Death and Myocardial Infarction Stratified by Stable and Unstable Coronary Artery Disease. Circulation: Cardiovascular Quality and Outcomes, 13(2), 1–15. https://doi.org/10.1161/CIRCOUTCOMES.119.006363

Chan, P. S., Brindis, R. G., Cohen, D. J., Jones, P. G., Gialde, E., Bach, R. G., Curtis, J., Bethea, C. F., Shelton, M. E., & Spertus, J. A. (2011). Concordance of physician ratings with the appropriate use criteria for coronary revascularization. Journal of the American College of Cardiology, 57(14), 1546–1553. https://doi.org/10.1016/j.jacc.2010.10.050

Desai, N. R., Bradley, S. M., Parzynski, C. S., Nallamothu, B. K., Chan, P. S., Spertus, J. A., Patel, M. R., Ader, J., Soufer, A., Krumholz, H. M., & Curtis, J. P. (2015). Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection, and Appropriateness of Percutaneous Coronary Intervention. JAMA, 314(19), 2045. https://doi.org/10.1001/jama.2015.13764

Gwon, H.-C., Jeon, D. W., Kang, H.-J., Jang, J.-S., Park, D.-W., Shin, D.-H., Moon, K.-W., Kim, J.-S., Kim, J., Bae, J.-W., Hur, S.-H., Kim, B. O., Choi, D., Han, K.-R., & Kim, H.-S. (2017). The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on the Year 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circulation Journal, 47(3), 320. https://doi.org/10.4070/kcj.2017.0070

Hadisoemarto, P. F., Tarsidin, N. F., Ariska, L., Wandira, R. D., Tiksnadi, B. B., Masytoh, L. S., Dany, F., & Sastroasmoro, S. (2021). OR8. Appropriateness of percutaneous coronary intervention procedure in Indonesia. European Heart Journal Supplements, 23(Supplement_F), 67–71. https://doi.org/10.1093/eurheartjsupp/suab122.007

Hannan, E. L., Samadashvili, Z., Cozzens, K., Gesten, F., Osinaga, A., Fish, D. G., Donahue, C. L., Bass, R. J., Walford, G., Jacobs, A. K., Venditti, F. J., Stamato, N. J., Berger, P. B., Sharma, S., & King, S. B. (2017). Changes in Percutaneous Coronary Interventions Deemed “Inappropriate” by Appropriate Use Criteria. Journal of the American College of Cardiology, 69(10), 1234–1242. https://doi.org/10.1016/j.jacc.2016.12.025

Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2024). Cochrane Handbook for Systematic Reviews of Interventions (6.5). Wiley Online Library. https://doi.org/10.1002/9781119536604

Khosravi, A., Ghodsi, S., Memarjafari, M., Nematollahi, A., Sheikh-Sharbafan, R., Sadre-Bafghi, S.-A., Moosavi, S.-V., Abdollahzadeh, M., Jalali, A., & Moshkani Farahani, M. (2023). Long-Term Major Adverse Cardiovascular Events in Patients with Moderate and Severe COVID-19: A Focus on Early Statin Use and Previous CVD. The Journal of Tehran University Heart Center, 18(3), 185–195. https://doi.org/10.18502/jthc.v18i3.14113

Klein, L. W., Tamis‐Holland, J., Kirtane, A. J., Anderson, H. V., Cigarroa, J., Duffy, P. L., Blankenship, J., Valentine, C. M., & Welt, F. G. (2021). The appropriate use criteria: Improvements for its integration into real world clinical practice. Catheterization and Cardiovascular Interventions, 98(7), 1349–1357. https://doi.org/10.1002/ccd.29784

Koshy, A. N., Stone, G. W., Sartori, S., Dhulipala, V., Giustino, G., Spirito, A., Farhan, S., Smith, K. F., Feng, Y., Vinayak, M., Salehi, N., Tanner, R., Hooda, A., Krishnamoorthy, P., Sweeny, J. M., Khera, S., Dangas, G., Filsoufi, F., Mehran, R., … Sharma, S. K. (2024). Outcomes Following Percutaneous Coronary Intervention in Patients With Multivessel Disease Who Were Recommended for But Declined Coronary Artery Bypass Graft Surgery. Journal of the American Heart Association, 13(11), 1–11. https://doi.org/10.1161/JAHA.123.033931

Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., Bittl, J. A., Cohen, M. G., Dimaio, J. M., Don, C. W., Fremes, S. E., Gaudino, M. F., Goldberger, Z. D., Grant, M. C., Jaswal, J. B., Kurlansky, P. A., Mehran, R., Metkus, T. S., Nnacheta, L. C., … Zwischenberger, B. A. (2022). 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(3), E18–E114. https://doi.org/10.1161/CIR.0000000000001038

Lin, S., Zhang, H., Chen, S.-P., Rao, C.-F., Wu, F., Zhou, F.-J., Wang, Y., Yan, H.-B., Dou, K.-F., Wu, Y.-J., Tang, Y.-D., Xie, L.-H., Guan, C.-D., Xu, B., & Zheng, Z. (2020). Mis-estimation of coronary lesions and rectification by SYNTAX score feedback for coronary revascularization appropriateness. Chinese Medical Journal, 133(11), 1276–1284. https://doi.org/10.1097/CM9.0000000000000827

Liu, Y., Chen, Y., Chang, Z., Han, Y., Tang, S., Zhao, Y., Fu, J., Liu, Y., & Fan, Z. (2023). Appropriateness of Percutaneous Coronary Interventions: A Systematic Review and Meta-Analysis. Journal of Cardiovascular Development and Disease, 10(3), 93. https://doi.org/10.3390/jcdd10030093

Mootz, N., Rojulpote, C., Verma, D., Harjai, K., & Lin, C.-J. (2024). Abstract 4132291: Assessing the Efficacy of Preventive Percutaneous Coronary Intervention vs Optimal Medical Therapy for the Treatment of Vulnerable Plaque: A Meta-analysis. Circulation, 150(Suppl_1), 171–185. https://doi.org/10.1161/circ.150.suppl_1.4132291

Panuccio, G., Carabetta, N., Torella, D., & De Rosa, S. (2024). Percutaneous coronary revascularization versus medical therapy in chronic coronary syndromes: An updated meta‐analysis of randomized controlled trials. European Journal of Clinical Investigation, 54(12), 1–13. https://doi.org/10.1111/eci.14303

Patel, M. R., Calhoon, J. H., Dehmer, G. J., Grantham, J. A., Maddox, T. M., Maron, D. J., & Smith, P. K. (2017). ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for T. Journal of the American College of Cardiology, 69(17), 2212–2241. https://doi.org/10.1016/j.jacc.2017.02.001

Patel, M. R., Dehmer, G. J., Hirshfeld, J. W., Smith, P. K., Spertus, J. A., Masoudi, F. A., Brindis, R. G., Dehraer, G. J., Beckman, K. J., Chambers, C. E., Ferguson, T. B., Garcia, M. J., Grover, F. L., Holmes, D. R., Klein, L. W., Limacher, M., Mack, M. J., Malenka, D. J., Park, M. H., … Weintraub, W. S. (2009). ACCF/SCAI/STS/AATS/AHA/ASNC 2009 appropriateness criteria for coronary revascularization. Circulation, 119(9), 1330–1352. https://doi.org/10.1161/CIRCULATIONAHA.108.191768

Patel, M. R., Dehmer, G. J., Hirshfeld, J. W., Smith, P. K., Spertus, J. A., Masoudi, F. A., Chamber, C. E., Ferguson, T. B., Garcia, M. J., Grover, F. L., Holmes, D. R., Klein, L. W., Limacher, M. C., MacK, M. J., Malenka, D. J., Park, M. H., Ragosta, M., Ritchie, J. L., Rose, G. A., … Allen, J. M. (2012). ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and I…. Journal of the American College of Cardiology, 59(9), 857–881. https://doi.org/10.1016/J.JACC.2011.12.001;PAGEGROUP:STRING:PUBLICATION

Patel, M. R., Dehmer, G. J., Hirshfeld, J. W., Smith, P. K., Spertus, J. A., Masoudi, F. A., Dehmer, G. J., Smith, P. K., Chambers, C. E., Ferguson, T. B., Garcia, M. J., Grover, F. L., Holmes, D. R., Klein, L. W., Limacher, M. C., Mack, M. J., Malenka, D. J., Park, M. H., Ragosta, M., Allen, J. M. (2012). ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and In. Journal of Thoracic and Cardiovascular Surgery, 143(4), 780–803. https://doi.org/10.1016/j.jtcvs.2012.01.061

Perera, D., Clayton, T., O’Kane, P. D., Greenwood, J. P., Weerackody, R., Ryan, M., Morgan, H. P., Dodd, M., Evans, R., Canter, R., Arnold, S., Dixon, L. J., Edwards, R. J., De Silva, K., Spratt, J. C., Conway, D., Cotton, J., McEntegart, M., Chiribiri, A., … Petrie, M. C. (2022). Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction. New England Journal of Medicine, 387(15), 1351–1360. https://doi.org/10.1056/NEJMoa2206606

Popova, Y. V., Kiselev, A. R., Sagaydak, O. V., Posnenkova, O. M., Gridnev, V. I., & Oshchepkova, E. V. (2021). Application of the Appropriate Use Criteria for Coronary Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation: Data from the Federal Registry. The Eurasian Journal of Medicine, 53(2), 96–101. https://doi.org/10.5152/eurasianjmed.2021.20004

Seixas, A. C., Sousa, A., de Ribamar Costa, J., Costa Moreira, A., Costa, R., Damiani, L., Campos Neto, C., Maldonado, G., Cano, M., & Sousa, J. E. (2017). Impact of PCI Appropriateness in the Long-Term Outcomes of Consecutive Patients Treated With Second-Generation Drug-Eluting Stents. The Journal of Invasive Cardiology, 29(9), 290–296. http://www.ncbi.nlm.nih.gov/pubmed/28623668

Soriano-Moreno, D. R., Fernandez-Guzman, D., Tuco, K. G., Soriano-Moreno, A. N., Ccami-Bernal, F., Coico-Lama, A. H., Gonzáles-Uribe, A. G., & Taype-Rondan, A. (2024). Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review. Heliyon, 10(5), e27210. https://doi.org/10.1016/j.heliyon.2024.e27210

Tricoci, P., Allen, J. M., Kramer, J. M., Califf, R. M., & Smith, S. C. (2009). Scientific evidence underlying the ACC/AHA clinical practice guidelines. Jama, 301(8), 831–841. https://doi.org/10.1001/jama.2009.205

Yang, J. X., Stevenson, M. J., Valsdottir, L., Ho, K., Spertus, J. A., Yeh, R. W., & Strom, J. B. (2020). Association between procedure appropriateness and patient-reported outcomes after percutaneous coronary intervention. Heart, 106(6), 441–446. https://doi.org/10.1136/heartjnl-2019-315835