June 21, 2026
View Full PaperComparative Trends in Percutaneous Coronary Intervention in Japan and the United States, 2013 to 2017
Key Result
Elective PCI was more than twice as common in Japan (72.7%) compared to the United States (33.8%; p<0.001), with computed tomography angiography also used much more frequently pre-procedurally.
Key Points
- This study aims to compare the trends in percutaneous coronary intervention (PCI) practices between Japan and the United States from 2013 to 2017.
- Utilized National Cardiovascular Data Registry CathPCI for the USA and J-PCI for Japan.
- Analyzed data from 1,752 hospitals in the USA and 1,108 hospitals in Japan.
- Summarized PCI volume, patient characteristics, pre-procedural testing, and quality metrics between 2013 and 2017.
- PCI volume increased by 15.8% in the USA (from 550,872 to 637,650) due to more nonelective procedures; p for trend <0.001.
- In Japan, PCI volume rose by 36% (from 181,750 to 247,274) mainly from elective procedures; p for trend <0.001.
- Elective PCI proportion was greater in Japan (72.7%) compared to the USA (33.8%); p < 0.001.
Study Design
Type
Observational
Multicenter
Yes
Structured PICO
How do temporal trends and practice patterns in percutaneous coronary intervention differ between Japan and the United States?
P
Population
Patients undergoing percutaneous coronary intervention between 2013 and 2017 across 1,752 hospitals in the United States and 1,108 hospitals in Japan.
E
Exposure
PCI practice patterns in Japan
C
Comparator
PCI practice patterns in the United States
O
Outcome
Temporal trends in procedural volume, patient characteristics, pre-procedural testing, procedural characteristics, and quality metrics
Contemporary PCI practice differs significantly between Japan and the US, with Japan performing more than twice as many elective PCIs and utilizing pre-procedural CT angiography much more frequently.
Main Result
Absolute Event Rate: 72.7% vs 33.8%
p-value: p=< 0.001
Abstract
BACKGROUND Adoption of the results of large-scale randomized controlled trials in percutaneous coronary intervention (PCI) may differ internationally, yet few studies have described the potential variations in PCI practice patterns. OBJECTIVES Using representative national registries, we compared temporal trends in procedural volume, patient characteristics, pre-procedural testing, procedural characteristics, and quality metrics in the United States and Japan. METHODS The National Cardiovascular Data Registry CathPCI was used to describe care in the United States, and the J-PCI was used to assess practice patterns in Japan (numbers of participating hospitals: 1,752 in the United States and 1,108 in Japan). Both registries were summarized between 2013 and 2017. RESULTS PCI volume increased by 15.8% in the United States from 550,872 in 2013 to 637,650 in 2017, primarily because of an increase in nonelective PCIs (p for trend 2-fold greater in Japan (72.7%) than in the United States (33.8%; p < 0.001). Overall, the ratio of nonelective PCI (vs. elective PCI; 27.3% vs. 66.2%; p < 0.001) and the performance of noninvasive stress testing in patients with stable disease (15.2% vs. 55.3%; p < 0.001) was lower in Japan than in the United States. Computed tomography angiography was more commonly used in Japan (22.3% vs. 2.0%; p < 0.001). CONCLUSIONS Elective PCI is more than twice as common in Japan as in the United States in contemporary practice. Computed tomography angiography is much more frequently used pre-procedurally in Japan than in the United States.