研究目的：美國2007年與2009年分別發表了COURAGE試驗與冠狀動脈重建術的適當性指標(AUC)，造成美國冠狀動脈介入治療使用量下降，使用不適當比例下降。本研究欲探討兩個主題，第一，冠狀動脈介入治療適應症比例之趨勢變化，及醫院差異。第二，檢視冠狀動脈介入治療使用的適當性比例。
研究方法：第一部分資料來源為「全民健康保險研究資料庫」之住院醫療費用清單明細檔，研究對象以處置碼擷取2000至2012年有使用冠狀動脈介入治療治療之個案，並依該次診斷碼疾病與其他手術區分適應症種類，再以潛在成長趨勢模型將醫院適應症比例趨勢變化進行分類，進一步比較各類醫院特徵的差異。第二部分資料來源為「2000年的承保抽樣歸人檔」，研究對象與適應症分類同上，接著以非侵入性檢查與藥物判定冠狀動脈介入治療使用的適當性，最後比較適當與不適當的醫院特徵差異。
結果：台灣冠狀動脈介入治療使用量從2000年13865次增加至2012年37426次，前期2000-2009年使用量直線大幅上升(斜率=2.3, P=0.005)，2009年後使用量仍直線增加但幅度漸趨平緩(斜率=0.7, P<0.001)。非急性適應症次數由2000年6837次增加至2012年12482次，其中2000-2009年間顯著直線上升(斜率:0.6, P=0.003)，但明顯於2009年後直線下降(斜率:-0.1, P<0.001)。非急性適應症比例由2000年49.3%減少至2012年33.4%。2000年至2012年醫院非急性適應症比例下降(2007年34.9%、2009年32.5%、2012年27.8%)，醫院差異增加(2000年IQR : 26.6%-41.5%、2009年IQR : 25.4%-39.1%、2012年IQR : 20.3%-39.4%)。將73家醫院非急性適應症比例年代變化分五類，五類之地區別有顯著差異，12%屬於高比例(50%以上)使用的族群，稱為「高高下降緩」相較於其他四組在北區(55.6%)、醫學中心(33.3%)、私立醫院(88.9%)的比例較高。另一部分，2000-2012年非急性適應症使用冠狀動脈介入治療有51.1%屬於適當、45.6%為可能適當、3.3%為不適當。非急性適應症不適當使用冠狀動脈介入治療於2005-2008年(41.1%)至2009-2012年(70.2%)支架使用比例增加1.7倍。
結論：本研究發現台灣確實隨著指引的變化，改變醫師行為，使非急性適應症次數於AUC後下降。但雖然整體次數下降，仍有醫院持續高比例做非急性適應症之冠狀動脈介入治療。為了提高醫療品質與達到有效利用醫療資源的目標，以量性資料尋找問題是重要的第一步，未來將嘗試分析問題醫院背後的原因，並鼓勵醫院提供患者風險訊息。

SUMMARY
We sought to examine trends in the use of percutaneous coronary interventions and regional variation in different indications of PCI in Taiwan. PCI procedures were identified from Taiwan National Health Insurance (NHI) inpatient claims database between 2000 and 2012. Of all PCI, 28.7 percent were for acute, 32.4 percent for other acute, and 38.9 for non-acute. The results indicated that the volume of non-acute PCI significantly decreased after the AUC was published in 2009. There was variation in proportion of non-acute PCI across different hospital levels (median=20.0, interquartile range 14.0% to 28.6%). It is good that Taiwan had followed the AUC to reduce the utilization of PCI in non-acute patients. But there are still some hospitals with higher proportion of non-acute PCI, suggesting an opportunity to improve healthcare quality through target investigation.

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