title: Interinstitutional variation in the use of abciximab for percutaneous coronary intervention.
abstract: BACKGROUND
  Several clinical trials have established abciximab as an efficacious agent for use in conjunction with percutaneous coronary intervention; however, there is little documented about its use in routine clinical practice in Canada.
  
  
  OBJECTIVE
  To determine the use of abciximab, and secondarily, its associations with one-year death and repeat revascularization rates in 2751 Alberta residents who underwent percutaneous coronary intervention in 1999.
  
  
  METHODS
  Descriptive statistics were used to determine use patterns. Logistic regression models were used to define risk of long-term outcomes and to determine associations between abciximab use and risk-adjusted death and repeat revascularization rates.
  
  
  RESULTS
  Abciximab was administered to 43.5% of the study population and interinstitutional differences were revealed (site A, 46.7%; site B, 26.6%; site C, 54.6%, P<0.001). Use patterns according to the adjusted risk of death or repeat revascularization also differed across these sites. There were no differences between patients treated with versus those treated without abciximab in risk-adjusted one-year mortality (3.7%, 95% CI 2.8% to 3.7% versus 3.1%, 95% CI 2.3% to 4.0%) or revascularization rates (16.7%, 95% CI 14.8% to 19.1% versus 15.8%, 95% CI 14.0% to 17.7%). However, differences in baseline clinical characteristics between these two groups may limit the inferences that can be made from these outcome comparisons.
  
  
  CONCLUSIONS
  Use patterns varied across the tertiary care hospitals in Alberta and the use of abciximab was not associated with reduced rates of long term death or repeat revascularization. The absence of provincial or national guidelines may have influenced the uptake and application of this novel therapy.
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.forename: L Duncan
authors.initials: LD
authors.lastname: Saunders
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
mesh_terms: D000077284:Abciximab; D000328:Adult; D000367:Age Factors; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab