The appropriateness of percutaneous transluminal coronary angioplasty in Korea

Background: The rapid adoption of percutaneous transluminal coronary angioplasty (PTCA) in Korea is provoking a widespread concern about possible overuse of this procedure with inappropriate indications. This study aimed to assess the rate of appropriate application of PTCA in Korea and investigate factors affecting this rate. Methods: An assessment tool was developed according to the Delphi-RAND technique, in which an expert panel of seven members (two cardiac surgeons, three interventional cardiologists, and two internists) was formed and its members rated mutually exclusive indications. Medical records of 1228 patients who underwent PTCA at 25 centers across Korea were analyzed based on the developed appropriateness criteria. Results: Overall, 13.2% of PTCA procedures were appropriate and 3.7% were inappropriate. By diagnoses, the rate of appropriateness was highest in acute myocardial infarction, and the rate of inappropriateness was highest in chronic stable angina. The appropriateness rate was correlated with the number of procedures performed at a hospital. In a multivariate analysis, diagnoses, risk, annual PTCA volume, number of PTCA interventionists, and interventionists’ training experience in foreign countries were significantly correlated with the appropriateness. Conclusions: The appropriateness and inappropriateness rates in Korea are comparable to those in countries in which PTCA has been introduced earlier and performed more frequently. However, the appropriateness in hospitals performing a small number of PTCA cases should be monitored and improved.