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Percutaneous coronary intervention in the current era compared with 1985-1986: the National Heart, Lung, and Blood
D O Williams1, R Holubkov, W Yeh
1Division of Cardiology, Rhode Island Hospital, Brown University, Providence, RI, USA.
Insights
Coronary angioplasty outcomes have improved significantly. Modern interventions show higher procedural success rates and lower complication rates compared to earlier methods, even with more complex patient cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Coronary angioplasty techniques have advanced over the last decade.
- Limited data exists on the impact of these refinements on patient outcomes.
Purpose of the Study:
- To compare outcomes of coronary interventions between two distinct time periods.
- To evaluate the effect of technological and procedural advancements on angioplasty results.
Main Methods:
- Retrospective comparison of 1559 patients from the 1997-1998 Dynamic Registry with 2431 patients from the 1985-1986 National Heart, Lung, and Blood Institute Registry.
- Analysis of baseline characteristics, procedural success, in-hospital outcomes, and 1-year follow-up data.
Main Results:
- Dynamic Registry patients were older, more often female, and presented with more acute myocardial infarction and complex lesions (severe, thrombotic, calcified).
- Stent use was significantly higher in the Dynamic Registry (70.5%) compared to balloon angioplasty alone in the earlier registry.
- Procedural success was higher (92.0% vs 81.8%), and combined in-hospital death, myocardial infarction, and emergency coronary bypass surgery rates were lower (4.9% vs 7.9%) in the Dynamic Registry.
- The 1-year rate for coronary artery bypass grafting (CABG) was also lower in the Dynamic Registry (6.9% vs 12.6%).
Conclusions:
- Despite presenting with more complex coronary disease, patients in the Dynamic Registry experienced superior procedural success and reduced complication rates.
- Percutaneous coronary intervention outcomes have demonstrably improved over the past decade due to advancements in technology and practice.
Background:
Although refinements have occurred in coronary angioplasty over the past decade, little is known about whether these changes have affected outcomes.
Methods And Results:
Baseline features and in-hospital and 1-year outcomes of 1559 consecutive patients in the 1997-1998 Dynamic Registry who were having first coronary intervention were compared with 2431 patients in the 1985-1986 National Heart, Lung, and Blood Institute Registry. Compared with patients in the 1985-1986 Registry, Dynamic Registry patients were older (mean age, 62 versus 58 years; P:<0.001) and more often female (32.1% versus 25.5%; P:<0.001). In the Dynamic Registry, procedures were more often performed for acute myocardial infarction (22.9% versus 9.9%; P:<0.001) and treated lesions were more severe (84.5% versus 82.5% diameter reduction; P:<0.001), thrombotic (22.1% versus 11.3%; P:<0.001) or calcified (29.5% versus 10.8%; P:<0.001). Stents were used in 70.5% of Dynamic Registry patients, whereas 1985-1986 patients received balloon angioplasty alone. Procedural success was higher in the Dynamic Registry (92.0% versus 81.8%; P:<0.001) and the rate of in-hospital death, myocardial infarction, and emergency coronary bypass surgery combined was lower (4.9% versus 7.9%; P:=0.001) than in the 1985-1986 Registry. The 1-year rate for CABG was lower in the Dynamic Registry (6.9% versus 12.6%; P:<0.001).
Conclusions:
Although Dynamic Registry patients had more unstable and complex coronary disease than those in the 1985-1986 Registry, their rate of procedural success was higher whereas rates of complications and subsequent CABG were lower. Results of percutaneous coronary intervention have improved substantially over the past decade.
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