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Trends in PCI volume after negative results from the COURAGE trial

David H Howard1, Yu-Chu Shen

  • 1Department of Health Policy and Management, Emory University, Atlanta, GA.

Health Services Research
|July 9, 2013
PubMed

Insights

Percutaneous coronary intervention (PCI) use decreased for stable angina patients after the COURAGE trial. Comparative effectiveness research influenced practice, though some patients still receive PCI.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Interventional Cardiology

Background:

  • The COURAGE trial demonstrated medical therapy's equivalence to percutaneous coronary intervention (PCI) for stable angina.
  • Post-trial, understanding shifts in PCI utilization for stable versus acute coronary syndromes is crucial.

Purpose of the Study:

  • To analyze trends in PCI volume following the COURAGE trial publication.
  • To differentiate PCI trends based on patient diagnosis: stable angina versus acute myocardial infarction (AMI) or unstable angina.

Main Methods:

  • Utilized comprehensive inpatient and outpatient discharge data from Florida, Maryland, and New Jersey.
  • Incorporated data from the English Hospital Episode Statistics database for international comparison.
  • Examined PCI volumes before and after the COURAGE trial across different diagnostic categories.

Main Results:

  • PCI use for stable angina in the US (FL, MD, NJ) decreased by 17% from 2006 to 2008.
  • No significant change in PCI volume was observed for patients with AMI.
  • Similar PCI trend declines were noted in US community hospitals, but not in England.

Conclusions:

  • The COURAGE trial's findings appear to have influenced US practice, leading to reduced PCI for stable angina.
  • Comparative effectiveness research can drive cost-saving practice pattern changes.
  • A notable number of patients with stable coronary disease continue to undergo PCI despite trial evidence.
Abstract

Keywords:
Medical decision makingaccessdemanddiffusiontechnology adoptionuseutilization of services

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