Clinical Studies
Changing outcomes in percutaneous coronary interventions: A study of 34,752 procedures in Northern New England, 1990 to 1997

was presented in part at the 71st Annual Scientific Session of the American Heart Association, Dallas, Texas, November 9–11, 1998.
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Abstract

OBJECTIVES

We sought to evaluate the changing outcomes of percutaneous coronary interventions (PCIs) in recent years.

BACKGROUND

The field of interventional cardiology has seen considerable growth in recent years, both in the number of patients undergoing procedures and in the development of new technology. In view of recent changes, we evaluated the experience of a large, regional registry of PCIs and outcomes over time.

METHODS

Data were collected from 1990 to 1997 on 34,752 consecutive PCIs performed at all hospitals in Maine (two), New Hampshire (two) and Vermont (one) supporting these procedures, and one hospital in Massachusetts. Univariate and multivariate regression analyses were used to control for case mix. Clinical success was defined as at least one lesion dilated to <50% residual stenosis and no adverse outcomes. In-hospital adverse outcomes included coronary artery bypass graft surgery (CABG), myocardial infarction and mortality.

RESULTS

Over time, the population undergoing PCIs tended to be older with increasing comorbidity. After adjustment for case mix, clinical success continued to improve from a low of 88.2% in earlier years to a peak of 91.9% in recent years (p trend <0.001). The rate of emergency CABG after PCI fell in recent years from a peak of 2.3% to 1.3% (p trend <0.001). Mortality rates decreased slightly from 1.2% to 1.1% (p trend 0.007).

CONCLUSIONS

There has been a significant improvement in clinical outcomes for patients undergoing PCIs in northern New England, including a significant decline in the need for emergency CABG.

Abbreviations

CABG
coronary artery bypass graft surgery
CPK
creatine phosphokinase
DCA
directional coronary atherectomy
EF
ejection fraction
IABP
intraaortic balloon pump
LAD
left anterior descending coronary artery
MI
myocardial infarction
NNECVDSG
Northern New England Cardiovascular Disease Study Group
PCI
percutaneous coronary intervention

Cited by (0)

This study was supported in part by a grant from the Agency for Health Care Policy and Research (HS06813) and

∗∗

A list of members appears in .