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Trend in percutaneous coronary intervention volume following the COURAGE and BARI-2D trials: insight from over 8.1

Sripal Bangalore1, Navdeep Gupta2, Philippe Généreux3

  • 1New York University School of Medicine, New York, NY, USA.

International Journal of Cardiology
|February 10, 2015
PubMed

Insights

Major trials like COURAGE and BARI-2D significantly reduced percutaneous coronary intervention (PCI) for stable ischemic heart disease. However, this also led to an unintended decrease in PCI for acute coronary syndromes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Services Research

Background:

  • Clinical trials like COURAGE and BARI-2D questioned the routine use of revascularization in stable ischemic heart disease (SIHD).
  • While a routine invasive strategy is beneficial for acute coronary syndrome (ACS), the impact of these trials on percutaneous coronary intervention (PCI) trends was unclear.

Purpose of the Study:

  • To analyze the impact of the COURAGE and BARI-2D trials on PCI volume trends for SIHD and ACS.
  • To assess changes in PCI utilization following landmark clinical trial publications.

Main Methods:

  • Utilized Nationwide Inpatient Sample data from 2001-2011 for discharges involving PCI.
  • Analyzed PCI volume trends, specifically in relation to the COURAGE (2007) and BARI-2D (2009) trial publications.
  • Calculated age and gender-adjusted PCI rates using direct standardization.

Main Results:

  • PCI volumes increased steadily until 2006, then declined significantly post-COURAGE/BARI-2D publication.
  • Overall PCI volume decreased by 38% from its 2006 peak, driven by a 60% reduction in SIHD PCI.
  • PCI for ACS also decreased by 20%, notably for unstable angina.

Conclusions:

  • The COURAGE and BARI-2D trials had a substantial impact on SIHD PCI volumes.
  • An unintended consequence was a significant decrease in PCI volumes for ACS patients.
Abstract

Keywords:
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