Practice and outcomes of percutaneous coronary intervention in the community before drug-eluting stents: a report from the HCA database.
BACKGROUND
Percutaneous coronary intervention (PCI) using balloon angioplasty and/or intracoronary stents has increasingly become the treatment choice for myocardial revascularization. While acute clinical outcomes of the community-based PCI procedures have been examined, much less is known about long-term revascularization rates, disease progression and other adverse outcomes.


RESULTS
Information on patient demographics, coronary risk factors, lesion characteristics, procedures and outcomes were derived from an HCA, Inc. database on all patients undergoing a PCI procedure in one of four community cardiac catheterization laboratories. A total of 3,192 consecutive patients were enrolled from July 1, 1999 through September 30, 2000. Analysis was limited to those patients undergoing PCI of native vessels with stents or conventional balloon angioplasty; target lesions in bypass grafts or those treated with atherectomy were excluded. Approximately one-third of enrolled patients were surveyed concerning their utilization of cardiovascular services 1 year following their initial procedure. The 1-year target lesion revascularization (TLR) was 9.9% while target vessel revascularization was 13.5%. Overall, 27.6% of patients underwent repeat revascularization within 1 year; 24.7% underwent at least 1 additional PCI and 5.6% underwent coronary artery bypass graft surgery. A total of 4.5% of patients reported an interval acute myocardial infarction with a major adverse cardiac event rate of 30.3% at 1 year.


CONCLUSIONS
While clinically significant restenosis remains a problem for 10 15% of patients undergoing PCI, progression of coronary artery disease elsewhere appears to be an equally powerful driver in the need for recurrent revascularization. This analysis of contemporary PCI practice prior to drug-eluting stent utilization suggests that while these novel devices will likely reduce the incidence of TLR, many patients with coronary artery disease will still require additional revascularization for disease progression.
Cohen
David J
DJ
Cardiovascular Division, Henry Ford Health System, Detroit, MI 48202, USA.
Houser
Frank
F
Mack
Michael
M
Simon
April W
AW
Battaglia
Salvatore L
SL
Tarkington
Lynn G
LG
Becker
Edmund R
ER
Culler
Steven D
SD
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D003153:Community Health Services; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible