Changing outcomes in percutaneous coronary interventions: a study of 34,752 procedures in northern New England, 1990 to 1997. Northern New England Cardiovascular Disease Study Group.
OBJECTIVE
We sought to evaluate the changing outcomes of percutaneous coronary interventions (PCIs) in recent years.


BACKGROUND
The field of interventional cardiology has seen considerable growth in recent years, both in the number of patients undergoing procedures and in the development of new technology. In view of recent changes, we evaluated the experience of a large, regional registry of PCIs and outcomes over time.


METHODS
Data were collected from 1990 to 1997 on 34,752 consecutive PCIs performed at all hospitals in Maine (two), New Hampshire (two) and Vermont (one) supporting these procedures, and one hospital in Massachusetts. Univariate and multivariate regression analyses were used to control for case mix. Clinical success was defined as at least one lesion dilated to <50% residual stenosis and no adverse outcomes. In-hospital adverse outcomes included coronary artery bypass graft surgery (CABG), myocardial infarction and mortality.


RESULTS
Over time, the population undergoing PCIs tended to be older with increasing comorbidity. After adjustment for case mix, clinical success continued to improve from a low of 88.2% in earlier years to a peak of 91.9% in recent years (p trend <0.001). The rate of emergency CABG after PCI fell in recent years from a peak of 2.3% to 1.3% (p trend <0.001). Mortality rates decreased slightly from 1.2% to 1.1% (p trend 0.007).


CONCLUSIONS
There has been a significant improvement in clinical outcomes for patients undergoing PCIs in northern New England, including a significant decline in the need for emergency CABG.
McGrath
P D
PD
Center for Outcomes Research and Evaluation, Department of Medicine, Maine Medical Center, Portland 04102, USA. mcgrap@mail.mmc.org
Malenka
D J
DJ
Wennberg
D E
DE
Shubrooks
S J
SJ
Bradley
W A
WA
Robb
J F
JF
Kellett
M A
MA
Ryan
T J
TJ
Hearne
M J
MJ
Hettleman
B
B
O'Meara
J R
JR
VerLee
P
P
Watkins
M W
MW
Piper
W D
WD
O'Connor
G T
GT
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000628:therapy; D003625:Data Collection / Q000379:methods; D004630:Emergencies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009511:New England; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data / Q000639:trends*; D011446:Prospective Studies