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. 2021 Oct:31:10-16.
doi: 10.1016/j.carrev.2020.12.019. Epub 2020 Dec 17.

Temporal Trends in Patient Risk Profile and Clinical Outcomes Following Percutaneous Coronary Intervention

Luke P Dawson  1 , Diem Dinh  2 , Stephen J Duffy  3 , David Clark  4 , Christopher M Reid  2 , Angela Brennan  2 , Nick Andrianopoulos  2 , Chin Hiew  5 , Melanie Freeman  6 , Ernesto Oqueli  7 , William Chan  8 , Andrew E Ajani  9 ; Melbourne Interventional Group (MIG) Investigators
Affiliations

Temporal Trends in Patient Risk Profile and Clinical Outcomes Following Percutaneous Coronary Intervention

Luke P Dawson et al. Cardiovasc Revasc Med. 2021 Oct.

Abstract

Background: Patient selection and procedural characteristics continue to evolve in percutaneous coronary intervention (PCI). Australian data on long-term trends and outcomes are limited. This study aimed to identify long-term temporal trends in patient characteristics and outcomes in a large Australian PCI cohort.

Methods: We analysed data from 41,146 PCI procedures included in the multi-centre Melbourne Interventional Group registry to determine trends in patient characteristics, procedural practices and outcomes from 2005 to 2018. Procedures were divided into 2-yearly periods for trends analysis.

Results: Temporal trends in patient characteristics showed increases in age, proportion of males, rates of obesity, insulin-requiring diabetes mellitus, current smoking, obstructive sleep apnoea and prior PCI (all Ptrend < 0.01). Increases in the proportion of ST-elevation myocardial infarction, cardiogenic shock or out-of-hospital cardiac arrest (OHCA) were observed, and CathPCI National Cardiovascular Data Registry mortality risk scores increased over time (all Ptrend < 0.01). Use of radial access and drug-eluting stents increased, and lesions treated were more frequently ostial, left main or ACC/AHA type B2/C in recent years (all Ptrend < 0.01). In contrast, major bleeding and no reflow rates declined, however 30-day mortality, 12-month mortality and rates of stroke increased (all Ptrend < 0.01). Rates of vascular complications and 30-day target vessel revascularisation remained similar. In multivariable analysis, 2-yearly time periods were not independently associated with risk of 30-day mortality or 30-day MACE.

Conclusions: Over the last 14 years, Australian PCI procedural complexity and patient risk profiles have increased. Higher mortality rates appear to relate to increased patient risk profile rather than procedural factors.

Keywords: Outcomes; Percutaneous coronary intervention; Quality in care; Trends.

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Conflict of interest statement

Declaration of competing interest None declared.

Comment in

  • #PCI2021: The Trend Is Our Friend.
    Yakubov SJ, Arshi A, Stiver K. Yakubov SJ, et al. Cardiovasc Revasc Med. 2021 Oct;31:17-18. doi: 10.1016/j.carrev.2021.07.003. Epub 2021 Aug 12. Cardiovasc Revasc Med. 2021. PMID: 34391682 No abstract available.

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