Twenty-year evolution of percutaneous coronary intervention and its impact on clinical outcomes: a report from the National Heart, Lung, and Blood Institute-sponsored, multicenter 1985-1986 PTCA and 1997-2006 Dynamic Registries

Abstract

Background: Percutaneous coronary intervention (PCI) has undergone rapid progress, both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking.

Methods and results: We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter, National Heart, Lung, and Blood Institute-sponsored 1985-1986 percutaneous transluminal coronary angioplasty (PTCA) and 1997-2006 Dynamic Registries waves (wave 1: 1997-1998, bare-metal stents; wave 2: 1999, uniform use of stents; wave 3: 2001-2002, brachytherapy; waves 4 and 5: 2004-2006, drug-eluting stents). Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9; wave 1, 2.7; wave 2, 2.8; wave 3, 1.9; wave 4, 2.6; wave 5, 2; P(trend)<0.001) and emergency coronary artery bypass surgery (PTCA Registry: 3.7; wave 1, 0.4; wave 2, 0.4; wave 3, 0.3; wave 4, 0.4; wave 5, 0; P(trend)<0.001). Compared with the PTCA Registry, risk for repeat revascularization (31 to 365 days after index PCI) was significantly lower in the dynamic waves (adjusted hazard ratio: wave 1, 0.72; wave 2, 0.51; wave 3, 0.51; wave 4, 0.30; wave 5, 0.36; P<0.05 for all).

Conclusions: Percutaneous interventions, in the last 2 decades, have evolved to include more urgent, comorbid cases, despite achieving high success rates with significantly reduced need for repeat revascularization.

Figure 1

Cumulative (Kaplan Meier) event rates for Death and Death/MI in the NHLBI-sponsored PTCA (1985–86) and Dynamic (1997–2006) Registries at one year

Figure 2

Adjusted Hazard ratios (95% confidence intervals) for Death and Death/MI in the 1997–2006 Dynamic Registry waves (reference: 1985–86 PTCA Registry)

Figure 3

Cumulative (Kaplan Meier) event rates for early (≤ 30 days) and late (31–365 days) CABG (A) and repeat PCI (B) in the NHLBI-sponsored PTCA (1985–86) and Dynamic (1997–2006) Registries.