Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
J Cardiol. 2022 Sep;80(3):275-282. doi: 10.1016/j.jjcc.2022.05.001. Epub 2022 May 21.
This study sought to elucidate the trend of noninvasive follow-up testing in Japan and its impact on subsequent resource use and clinical outcomes after drug-eluting stent (DES) implantation.
This retrospective study used data from a Japanese nationwide administrative database. We performed trend analyses for patients who underwent DES implantation from 2013 to 2019 and further analyzed who received at least one noninvasive follow-up testing. We compared stress electrocardiography (ECG), coronary computed tomography angiography (CCTA), and myocardial perfusion imaging (MPI) and outcomes using inverse probability weighting with generalized propensity scores. Primary outcomes included subsequent coronary angiography (CAG) and re-percutaneous coronary intervention (re-PCI).
In trend analysis, 23.7% of patients underwent noninvasive follow-up testing, and 47.5% underwent CAG without preceding noninvasive follow-up testing. Total follow-up tests and CAG declined, whereas stress ECG, CCTA, and MPI increased (p for trend <0.001 for all). Among 32,850 patients who underwent noninvasive follow-up tests, 7465 (22.7%), 12,617 (38.4%), and 12,768 (38.9%) patients underwent stress ECG, CCTA, and MPI, respectively. Both CCTA and MPI were associated with a lower risk of subsequent CAG [CCTA vs. stress ECG, hazard ratio (HR): 0.28, 95% confidence interval (CI): 0.26 to 0.31; MPI vs. stress ECG, HR: 0.61, 95% CI: 0.57-0.66], but both CCTA and MPI were associated with a higher risk of re-percutaneous coronary intervention (CCTA vs. stress ECG, HR: 1.21, 95% CI: 1.06-1.37; MPI vs. stress ECG, HR, 1.25; 95% CI, 1.10-1.43) than stress ECG.
More than half of the patients had undergone a follow-up test after DES implantation within two years of PCI with DES implantation. Total follow-up tests and CAG decreased, but noninvasive follow-up tests increased. Neither CCTA nor MPI are recommended for initial follow-up testing after PCI because they were associated with the higher risk of re-PCI than stress ECG.
本研究旨在阐明日本非侵入性随访检测的趋势及其对药物洗脱支架（DES）植入后后续资源利用和临床结局的影响。
本回顾性研究使用了来自日本全国行政数据库的数据。我们对 2013 年至 2019 年接受 DES 植入术的患者进行了趋势分析，并进一步分析了至少接受过一次非侵入性随访检测的患者。我们使用广义倾向评分的逆概率加权法比较了应激心电图（ECG）、冠状动脉计算机断层扫描血管造影（CCTA）和心肌灌注成像（MPI）的结果。主要结局包括随后的冠状动脉造影（CAG）和再次经皮冠状动脉介入治疗（re-PCI）。
在趋势分析中，23.7%的患者接受了非侵入性随访检测，47.5%的患者在没有进行非侵入性随访检测的情况下进行了 CAG。总随访检测和 CAG 减少，而应激 ECG、CCTA 和 MPI 增加（所有 P 值均<0.001）。在 32850 名接受非侵入性随访检测的患者中，分别有 7465 名（22.7%）、12617 名（38.4%）和 12768 名（38.9%）患者接受了应激 ECG、CCTA 和 MPI 检查。CCTA 和 MPI 均与随后 CAG 的风险降低相关[CCTA 与应激 ECG 相比，风险比（HR）：0.28，95%置信区间（CI）：0.26 至 0.31；MPI 与应激 ECG 相比，HR：0.61，95%CI：0.57-0.66]，但与应激 ECG 相比，CCTA 和 MPI 均与再次经皮冠状动脉介入治疗（CCTA 与应激 ECG 相比，HR：1.21，95%CI：1.06-1.37；MPI 与应激 ECG 相比，HR：1.25，95%CI：1.10-1.43）的风险增加。
DES 植入后两年内，超过一半的患者在 DES 植入后进行了随访检查。总随访检测和 CAG 减少，但非侵入性随访检测增加。CCTA 和 MPI 均不建议用于 PCI 后的初始随访检查，因为与应激 ECG 相比，它们与再次 PCI 的风险增加有关。
