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Temporal trends in percutaneous coronary interventions thru the drug eluting stent era: Insights from 18,641 procedures performed over 12‐year period
Author(s) -
Landes Uri,
Bental Tamir,
Levi Amos,
Assali Abid,
VakninAssa Hana,
Lev Eli I.,
Rechavia Eldad,
Greenberg Gabriel,
Orvin Katia,
Kornowski Ran
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27375
Subject(s) - medicine , percutaneous coronary intervention , conventional pci , cardiology , stent , angioplasty , drug eluting stent , revascularization , percutaneous , myocardial infarction , surgery
Background The last decade, regarded as the DES era in PCI, has witnessed significant advances in the management of coronary disease. We aimed to assess temporal trends in the practice and outcome of percutaneous coronary intervention (PCI) during the drug eluting stent (DES) era. Methods We analyzed 18,641 consecutive PCI's performed between January 2004 and December 2016, distinguished by procedural date ( Q 1 : 2004–2006, n = 4,865; Q 2 : 2007–2009, n = 4,977; Q 3 : 2010–2012, n = 4,230; Q 4 : 2013–2016, n = 4,569). Results At presentation, mean patients age was 65 (±11) years and 22.8% were females. Over time, there was a rise in the relative number of octogenarians ( Q 1 : 10.7% vs Q 4 : 15.5%, P < 0.001) and an increase in the burden of most comorbidities (e.g., left ventricular dysfunction ≥ moderate and chronic kidney disease, P < 0.001 for both). Despite a 2‐fold increase in the rate of complex interventions, and a 3‐fold increase in the rate of unprotected left‐main angioplasty ( P < 0.001 for both), the radial approach was increasingly adopted ( Q 1 : 2% to Q 4 : 63.5%, P < 0.001). DES implantation increased from 43% to 83% at the expense of bare metal stent (BMS) application, and accompanied by drug coated balloon sprout to 1.8%, P < 0.001. Kaplan–Meier survival curves revealed a time‐based enhanced outcome, with a decreased rate of death, MI, target vessel revascularization and CABG over the years. Conclusions In the last decade, PCI has evolved to offer better outcome to more elderly, sicker patient population, with more complex coronary disease interventions. The shift to second generation DES and to enhanced PCI techniques may explain part of this progress.