Application of the Appropriate Use Criteria for Coronary Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation: Data from the Federal Registry

Abstract

Objective: The aim of the study was to apply the appropriate use criteria (AUC) for coronary revascularization on Russian Acute Coronary Syndrome Registry (RusACSR) data to analyze validity of the decision toperform percutaneous coronary interventions (PCIs) among patients with acute coronary syndrome (ACS).Material and Methods: In Russia, the frequency of performing PCI increased almost 7.5 times, and morethan half of all interventions were performed in patients with ACS, in the period from 2006 to 2015. AUC2012 were used to assess PCI appropriateness. Data were exported from RusACSR from a period of January 1, 2016 to December 31, 2016. We analyzed 33 893 cases, but 13 957 patients were excluded owing toabsence of data needed. The study group therefore included 19936 patients with ACS (mean age, 65.3 ±11.9 years; 40.3% women), and it was divided into 2 subgroups: 13 757 (67.2%) patients who were treatedconservatively and 6179 (32.8%) patients who underwent PCI. According to AUC, physicians’ choice ofstrategy was validated.Results: Patients treated conservatively differed significantly (P < .001) from those who underwent PCI.In this group, non-ST segment elevation ACS was significantly more common than in the group of patientswho received PCI (84.4% vs. 43.9%, P < .001). They also had more severe clinical status. According to AUC,among patients with ACS treated with PCI, the decision was warranted in 86.3% (valid decision). In 7.6% ofcases, there was no need for PCI. Among patients who underwent conservative treatment, 77.7% of patientsneeded PCI according to AUC. According to our data, only 3.8% of patients who were treated conservativelydid not need PCI. Appropriateness of invasive treatment was uncertain in 18.5% and 6.1% in the PCI andnon-PCI groups, respectively. All differences were significant (P < .001).Conclusion: AUC implementation showed low availability of PCI for patients with non-ST segment elevationACS accompanied by complicated clinical status. AUC for coronary revascularization could be applied in Russian clinical practice for unbiased PCI candidate selection and for evaluation of decision validity