title: Recent trends in Australian percutaneous coronary intervention practice: insights from the Melbourne Interventional Group registry.
abstract: OBJECTIVE
  To evaluate percutaneous coronary intervention (PCI) practice trends and 12-month outcomes in Australia in the era of drug-eluting stents (DES).
  
  
  METHODS
  Prospective study of consecutive patients undergoing 9204 PCIs between 1 April 2004 and 31 March 2008 at seven Victorian public hospitals.
  
  
  METHODS
  Temporal trends in baseline characteristics and in-hospital and 12-month clinical outcomes including death, myocardial infarction (MI), target vessel revascularisation (TVR) and composite major adverse cardiac events (MACE), from year to year.
  
  
  RESULTS
  Between 2004-2005 and 2007-2008, the mean age of patients undergoing PCI was stable (65 ± 12 years), and comorbidities such as hypertension, hyperlipidaemia, peripheral arterial disease and stroke increased (P < 0.05). There were fewer elective and more urgent PCIs, especially for MI < 24 hours (17.6% in 2004-2005 to 27.2% in 2007-2008, P < 0.01). Overall stent use remained high (mean, 94.6%), but use of DES declined steadily (53.9% in 2004-2005 to 32.0% in 2007-2008, P < 0.01), despite increases in complex lesions. Planned clopidogrel therapy of ≥ 12 months after insertion of DES increased from 54.7% in 2004-2005 to 98.0% in 2007-2008 (P < 0.01). The overall procedural success rate was high (mean, 95.9%), and 12-month rates of mortality (3.8%), MI (4.8%), TVR (6.8%) and stent thrombosis (1.8%) remained low. Selective use of DES was an independent predictor of freedom from MACE at 12 months (odds ratio, 0.68; 95% CI, 0.56-0.81).
  
  
  CONCLUSIONS
  Use of DES declined steadily from 2004-2005 to 2007-2008, despite increasing patient risk profile and lesion complexity. Procedural success remained high and 12-month adverse outcomes remained low, with increasing use of prolonged dual antiplatelet therapy.
authors.affiliation: Chinese University of Hong Kong, Hong Kong. bryan.yan@cuhk.edu.hk
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: Angela L
authors.initials: AL
authors.lastname: Brennan
authors.forename: Philippa
authors.initials: P
authors.lastname: Loane
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data / Q000639:trends*; D001315:Australia / Q000453:epidemiology; D000077144:Clopidogrel; D015897:Comorbidity; D054059:Coronary Occlusion / Q000453:epidemiology; D023903:Coronary Restenosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000453:epidemiology; D012770:Shock, Cardiogenic / Q000453:epidemiology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine