title: Trend in percutaneous coronary intervention volume following the COURAGE and BARI-2D trials: insight from over 8.1 million percutaneous coronary interventions.
abstract: BACKGROUND
  COURAGE and BARI-2D have questioned the utility of routine revascularization for the prevention of cardiovascular events in patients with stable ischemic heart disease (SIHD). On the other end of the spectrum, a routine invasive strategy in patients with acute coronary syndrome (ACS) is superior to a conservative strategy. The impact of the above trials on the trend in percutaneous coronary intervention (PCI) volume for SIHD and ACS is not known.
  
  
  METHODS
  Data from the 2001-2011 Nationwide Inpatient Sample for discharges with PCI were used. The trend in PCI volume over time was analyzed, especially in relation to the COURAGE (2007) and the BARI-2D (2009) trials. Age and gender adjusted PCI rates were calculated using direct standardization method.
  
  
  RESULTS
  Among the 8,150,764 PCI procedures, there was a steady increase in PCI volumes until the publication of the COURAGE/BARI-2D trials after which the volume decreased. Compared to the peak volume of 909,331 in 2006, PCI volume declined by 38% to 562,036 in 2011 (P<0.0001); driven by a 60% decrease in PCI for SIHD from 409,199 in 2006 to 160,707 in 2011 (P<0.0001). Moreover, there was a 20% decrease in PCI for ACS from 500,132 in 2006 to 401,330 in 2011 (P<0.0001) driven by a significant decrease in PCI for unstable angina. Results were similar in diabetics with a decline in the volume after BARI-2D trial, although the decline was less dramatic.
  
  
  CONCLUSIONS
  The 11-year trend indicates a substantial impact of COURAGE/BARI-2D on SIHD PCI volumes with an unintended consequence of lower PCI volumes for ACS.
authors: New York University School of Medicine, New York, NY, USA. Electronic address: sripalbangalore@gmail.com.
authors: Sripal
authors: S
authors: Bangalore
authors: Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Navdeep
authors: N
authors: Gupta
authors: Columbia University Medical Center and the Cardiovascular Research Foundation, Hôpital du Sacré-Coeur de Montréal, Québec, Montréal, Canada.
authors: Philippe
authors: P
authors: Généreux
authors: New York University School of Medicine, New York, NY, USA.
authors: Yu
authors: Y
authors: Guo
authors: Commonwealth Medical College, Scranton, PA, USA.
authors: Samir
authors: S
authors: Pancholy
authors: New York University School of Medicine, New York, NY, USA.
authors: Frederick
authors: F
authors: Feit
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends
keywords: Diabetes; PCI; Volume