title: Impact of the introduction of drug eluting stents on clinical outcomes in patients undergoing percutaneous and surgical coronary artery revascularisation procedures in Western Australia.
abstract: BACKGROUND
  Increasing rates of percutaneous coronary intervention (PCI) and decreasing rates of coronary artery bypass graft (CABG) surgery followed the introduction of drug eluting stents in Western Australia in 2002. We assessed the impact of these changes on one-year outcomes for the total population of patients undergoing coronary artery revascularisation procedures (CARP) in Western Australia between 2000-2004.
  
  
  METHODS
  Clinical and linked administrative data (inpatient admissions and death) were merged for all patients who had their first CARP with stent or CABG in Western Australia between 2000-2004. The clinical data were collected from all hospitals in Western Australia where CARP procedures are performed. We calculated the unadjusted (Kaplan-Meier) and adjusted (Cox) risks for one-year death (all-cause), death (all-cause) or admission for myocardial infarction (MI), target vessel revascularisation (TVR) and the composite outcome of death/MI/TVR (major adverse cardiac events, MACE).
  
  
  RESULTS
  Over the study period, there were 14,118 index CARPs. The use of drug eluting stents increased from 0% to 95.8% of PCI procedures, and PCI procedures increased from 61.1% to 74.4% of all CARPS. There were no temporal changes in adjusted one-year mortality or death/MI. Overall, adjusted one-year MACE fell from 11.3% in 2000 to 8.5% in 2004 (p<0.0001) due to a significant reduction in TVR in the PCI group.
  
  
  CONCLUSIONS
  The introduction of drug eluting stents and resulting changes in coronary revascularisation strategies were not associated with changes in the one-year risk of major clinical endpoints (death or death/MI), but were associated with a significant reduction in the risk of MACE, driven entirely by a reduction in TVR after PCI. This real world study supports the effectiveness of drug eluting stents in reducing repeat procedures in the total CARP population without increasing the risk of death or MI.
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia. frank.sanfilippo@uwa.edu.au
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rankin
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
authors.forename: Michael
authors.initials: M
authors.lastname: Nguyen
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.forename: Patricia
authors.initials: P
authors.lastname: Berg
authors.forename: Eric G
authors.initials: EG
authors.lastname: Whitford
authors.forename: Randall
authors.initials: R
authors.lastname: Hendriks
authors.forename: Bernard E
authors.initials: BE
authors.lastname: Hockings
authors.forename: Michael
authors.initials: M
authors.lastname: Muhlmann
authors.forename: Mark
authors.initials: M
authors.lastname: Newman
authors.forename: Robert
authors.initials: R
authors.lastname: Larbalestier
authors.forename: Ian
authors.initials: I
authors.lastname: Gilfillan
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Briffa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology