循環器ジャーナル65巻4号

2017年10月発行

特集 ACSの診断と治療はどこまで進歩したのか Ⅲ．ACSの治療

冠動脈インターベンションの適切な適応—appropriate use criteriaの視点から

著者： 猪原拓¹ 香坂俊²

所属機関： ^{1 2}慶應義塾大学医学部循環器内科

ページ範囲：P.652 - P.658

Point
・適応適切性基準（appropriate use criteria;AUC）とは，エビデンスに準拠したエキスパートオピニオンをシナリオ別に集約し，現場にわかりやすい形式で提示したものである．
・冠動脈インターベンション（PCI）のAUCは「安定狭心症の予後の改善は狭窄の解除のみに依って図られるものではない」という知見の集積に基づき，その過剰使用を戒めるための自浄努力の一環として米国で生まれた．
・米国におけるAUCの評価を検討することは，本邦におけるPCIを取り巻く問題点を明確にすることにつながるものと考えられる．

参考文献

1) Sedlis SP, Hartigan PM, Teo KK, et al:Effect of pci on long-term survival in patients with stable ischemic heart disease. N Engl J Med 373:1937-1946, 2015

2) Patel MR, Dehmer GJ, Hirshfeld JW, et al:ACCF/SCAI/STS/AATS/AHA/ASNC 2009 appropriateness criteria for coronary revascularization:A report by the american college of cardiology foundation appropriateness criteria task force, society for cardiovascular angiography and interventions, society of thoracic surgeons, american association for thoracic surgery, american heart association, and the american society of nuclear cardiology endorsed by the american society of echocardiography, the heart failure society of america, and the society of cardiovascular computed tomography. J Am coll Cardiol 53:530-553, 2009

3) Patel MR, Dehmer GJ, Hirshfeld JW, et al: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 interventions, society of thoracic surgeons, american association for thoracic surgery, american heart association, american society of nuclear cardiology, and the society of cardiovascular computed tomography. J Am coll Cardiol 59:857-881, 2012

4) Patel MR, Calhoon JH, Dehmer GJ, et al: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 thoracic surgery, american heart association, american society of echocardiography, american society of nuclear cardiology, society for cardiovascular angiography and interventions, society of cardiovascular computed tomography, and society of thoracic surgeons. J Am Coll Cardiol 69:2212-2241, 2017

5) Patel MR, Calhoon JH, Dehmer GJ, et al:ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 appropriate use criteria for coronary revascularization in patients with acute coronary syndromes:A report of the american college of cardiology appropriate use criteria task force, american association for thoracic surgery, american heart association, american society of echocardiography, american society of nuclear cardiology, society for cardiovascular angiography and interventions, society of cardiovascular computed tomography, and the society of thoracic surgeons. J Am Coll Cardiol 69:570-591, 2017

6) Chan PS, Patel MR, Klein LW, et al:Appropriateness of percutaneous coronary intervention. JAMA 306:53-61, 2011

7) Desai NR, Bradley SM, Parzynski CS, et al:Appropriate use criteria for coronary revascularization and trends in utilization, patient selection, and appropriateness of percutaneous coronary intervention. JAMA 2045-2053, 2015

8) Inohara T, Kohsaka S, Miyata H, et al:Appropriateness ratings of percutaneous coronary intervention in Japan and its association with the trend of noninvasive testing. JACC Cardiovasc Interv 7:1000-1009, 2014

9) Inohara T, Kohsaka S, Ueda I, et al:Application of appropriate use criteria for percutaneous coronary intervention in Japan. World J Cardiol 8:456-463, 2016

10) Inohara T, Kohsaka S, Miyata H, et al:Appropriateness of coronary interventions in Japan by the US and Japanese standards. Am Heart J 168:854-861. e11, 2014

11) Nishigaki K, Yamazaki T, Kitabatake A, et al:Percutaneous coronary intervention plus medical therapy reduces the incidence of acute coronary syndrome more effectively than initial medical therapy only among patients with low-risk coronary artery disease a randomized, comparative, multicenter study. JACC Cardiovasc Interv 1:469-479, 2008

12) JCS Joint Working Group:Guidelines for elective percutaneous coronary intervention in patients with stable coronary artery disease（JCS 2011）published in 2012. Circ J 77:1590-1607, 2013

13) Wald DS, Morris JK, Wald NJ, et al:Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med 369:1115-1123, 2013