BACKGROUND The American College of Cardiology/American Heart Association Appropriate Use Criteria were designed to aid clinical decision-making, yet their association with health status outcomes after chronic total occlusion percutaneous coronary intervention (PCI) is unknown. METHODS We analyzed 769 patients with baseline and 1-year health status data after chronic total occlusion PCI. Procedures were categorized as appropriate, may be appropriate, or rarely appropriate. Mean changes in patient-reported health status, assessed by the Seattle Angina Questionnaire (SAQ), were compared across appropriate use criteria categories from baseline to 1 year. Change in SAQ summary score was stratified as little to no benefit (≤10 points), intermediate (10-19 points), large (20-29 points), and very large (≥30 points). RESULTS The appropriate use criteria indication was appropriate in 573 patients (74.5%), may be appropriate in 191 (24.8%), and rarely appropriate in 5 (0.7%). Patients in the appropriate group reported greater improvement in SAQ summary scores (27.3±21.3 points) at 1 year compared with the may be appropriate (22.5±20.9; P=0.01). A similar pattern was noted for SAQ angina frequency (mean change 24.0±27.2 versus 18.7±25.6; P=0.02). The appropriate group had the highest proportion of very large improvements in SAQ summary scores (44.5% versus 33.3%; P=0.01). CONCLUSIONS Among patients undergoing chronic total occlusion PCI, the rate of rarely appropriate PCI was low. The rate of appropriate PCI was high and was associated with the greatest health status improvement at 1 year. A substantial proportion of patients in the may be appropriate group experienced meaningful health status benefits as well.

中文翻译：

---

慢性完全闭塞后经皮冠状动脉介入治疗后，适当的使用标准和健康状态结果：OPEN-CTO注册中心的见解。

背景技术美国心脏病学会/美国心脏协会的适当使用标准旨在帮助临床决策，但是在慢性完全阻塞性经皮冠状动脉介入治疗（PCI）后，它们与健康状况结果的关联尚不清楚。方法我们分析了769例慢性完全闭塞PCI后的基线和1年健康状况数据。程序被分类为适当，可能适当或很少适当。比较了西雅图心绞痛问卷（SAQ）评估的患者报告的健康状况的平均变化，涵盖了从基线到1年的适当使用标准类别。SAQ总结分数的变化分为：从无到有（≤10分），中级（10-19分），大（20-29分）和非常大（≥30分）。结果适当的使用标准适应症适用于573例患者（74.5％），可能适用于191例（24.8％），很少适用于5例（0.7％）。与适当组相比，适当组的患者在1年时SAQ汇总评分（27.3±21.3分）有更大的改善（22.5±20.9； P = 0.01）。对于SAQ心绞痛频率也观察到了类似的模式（平均变化24.0±27.2与18.7±25.6； P = 0.02）。适当的组在SAQ汇总评分中有非常大的改善的比例最高（44.5％对33.3％； P = 0.01）。结论在接受慢性完全闭塞PCI的患者中，很少进行合适的PCI的比率很低。合适的PCI发生率很高，并且与1年时健康状况的最大改善相关。