Korean Circ J.  2017 May;47(3):320-327. 10.4070/kcj.2017.0070.

The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

• Gwon HC
• Jeon DW
• Kang HJ
• Jang JS
• Park DW
• Shin DH
• Moon KW
• Kim JS
• Kim J
• Bae JW
• Hur SH
• Kim BO
• Choi D
• Han KR
• Kim HS

• KMID: 2385386
• DOI: http://doi.org/10.4070/kcj.2017.0070

Abstract

BACKGROUND AND OBJECTIVES
Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied.
MATERIALS AND METHODS
The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry.
RESULTS
The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center.
CONCLUSION
We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.

Keyword

Percutaneous coronary intervention; Appropriateness criteria; Clinical practice

MeSH Terms

Area Under Curve
Classification
Cohort Studies*
Consensus
Coronary Artery Bypass
Delivery of Health Care
Humans
Korea*
Percutaneous Coronary Intervention*
Transplants

Figure

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  Fig. 1 The proportion of class A, B and C cases according to clinical and angiographic variables.

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  Fig. 2 The proportion of class C cases among hospitals. (A) In all hospitals, median proportion was 2.0% (interquartile range 0.5-5.2%), (B) by geographic region.

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  Fig. 3 Determining factors of the proportion of class C in the hospital. (A) Relationship between the proportion of class C cases and the number of PCIs performed in the hospital. (B) Relationship between the proportion of class C cases and the proportion of ACS cases in the hospital. The geographic region of the hospital is indicated as follows; Seoul as an open circle, Gyeonggi province as a gray circle, and other provinces as closed circles. PCI: percutaneous coronary intervention, ACS: acute coronary syndrome.

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