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Recent trends in Australian percutaneous coronary intervention practice: insights from the Melbourne Interventional Group registry
Author(s) -
Yan Bryan P,
Ajani Andrew E,
Clark David J,
Duffy Stephen J,
Andrianopoulos Nick,
Brennan Angela L,
Loane Philippa,
Reid Christopher M
Publication year - 2011
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2011.tb03238.x
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , myocardial infarction , stent , odds ratio , clopidogrel , drug eluting stent , coronary artery disease , stroke (engine) , cardiology , surgery , mechanical engineering , engineering
Objective: To evaluate percutaneous coronary intervention (PCI) practice trends and 12‐month outcomes in Australia in the era of drug‐eluting stents (DES). Design, setting and patients: Prospective study of consecutive patients undergoing 9204 PCIs between 1 April 2004 and 31 March 2008 at seven Victorian public hospitals. Main outcome measures: Temporal trends in baseline characteristics and in‐hospital and 12‐month clinical outcomes including death, myocardial infarction (MI), target vessel revascularisation (TVR) and composite major adverse cardiac events (MACE), from year to year. Results: Between 2004–2005 and 2007–2008, the mean age of patients undergoing PCI was stable (65 ± 12 years), and comorbidities such as hypertension, hyperlipidaemia, peripheral arterial disease and stroke increased ( P < 0.05). There were fewer elective and more urgent PCIs, especially for MI < 24 hours (17.6% in 2004–2005 to 27.2% in 2007–2008, P < 0.01). Overall stent use remained high (mean, 94.6%), but use of DES declined steadily (53.9% in 2004–2005 to 32.0% in 2007–2008, P < 0.01), despite increases in complex lesions. Planned clopidogrel therapy of ≥ 12 months after insertion of DES increased from 54.7% in 2004–2005 to 98.0% in 2007–2008 ( P < 0.01). The overall procedural success rate was high (mean, 95.9%), and 12‐month rates of mortality (3.8%), MI (4.8%), TVR (6.8%) and stent thrombosis (1.8%) remained low. Selective use of DES was an independent predictor of freedom from MACE at 12 months (odds ratio, 0.68; 95% CI, 0.56–0.81). Conclusions: Use of DES declined steadily from 2004–2005 to 2007–2008, despite increasing patient risk profile and lesion complexity. Procedural success remained high and 12‐month adverse outcomes remained low, with increasing use of prolonged dual antiplatelet therapy.