Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: a report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985-1986 PTCA and 1997-2006 Dynamic Registries.
BACKGROUND
Percutaneous coronary intervention (PCI) has undergone rapid progress, both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking.


RESULTS
We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter, National Heart, Lung, and Blood Institute-sponsored 1985-1986 percutaneous transluminal coronary angioplasty (PTCA) and 1997-2006 Dynamic Registries waves (wave 1: 1997-1998, bare-metal stents; wave 2: 1999, uniform use of stents; wave 3: 2001-2002, brachytherapy; waves 4 and 5: 2004-2006, drug-eluting stents). Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9; wave 1, 2.7; wave 2, 2.8; wave 3, 1.9; wave 4, 2.6; wave 5, 2; P(trend)<0.001) and emergency coronary artery bypass surgery (PTCA Registry: 3.7; wave 1, 0.4; wave 2, 0.4; wave 3, 0.3; wave 4, 0.4; wave 5, 0; P(trend)<0.001). Compared with the PTCA Registry, risk for repeat revascularization (31 to 365 days after index PCI) was significantly lower in the dynamic waves (adjusted hazard ratio: wave 1, 0.72; wave 2, 0.51; wave 3, 0.51; wave 4, 0.30; wave 5, 0.36; P<0.05 for all).


CONCLUSIONS
Percutaneous interventions, in the last 2 decades, have evolved to include more urgent, comorbid cases, despite achieving high success rates with significantly reduced need for repeat revascularization.
Venkitachalam
Lakshmi
L
Cardiovascular Institute, Department of Medicine, School of Medicine, University of Pittsburgh, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa, USA.
Kip
Kevin E
KE
Selzer
Faith
F
Wilensky
Robert L
RL
Slater
James
J
Mulukutla
Suresh R
SR
Marroquin
Oscar C
OC
Block
Peter C
PC
Williams
David O
DO
Kelsey
Sheryl F
SF
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000639:trends*; D001918:Brachytherapy / Q000639:trends; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000639:trends; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D054555:National Heart, Lung, and Blood Institute (U.S.) / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D008670:Metals