Coronary Revascularization in the Real World: Evidence, Policy, and Practice in Japan | JACC Baran

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Shun Kohsaka, MD (Keio University School of Medicine) and Prof. Noboru Motomura, MD (Toho University Sakura Medical Center) to discuss their JACC study examining nationwide trends in coronary revascularization across Japan. Using two of the country’s largest all-Japan registries—the J-PCI registry and the JCVSD—this analysis tracks how PCI and CABG volumes evolved from a steady decline to a post-2020 plateau, amid major external influences including ISCHEMIA trial results, reimbursement policy changes, and the COVID-19 pandemic. The conversation highlights how evidence, health policy, and clinical practice interact at a national level, offering rare insight into why revascularization patterns in stable coronary disease did not continue to fall despite shifting evidence, and what this means for the future of ischemic heart disease care in Japan.