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J Am Coll Cardiol, 1999; 34:674-680 © 1999 by the American College of Cardiology Foundation |
* Center for Outcomes Research and Evaluation and the Division of Cardiology, Department of Medicine, Maine Medical Center, Portland, Maine, USA
Section of Cardiology, Departments of Medicine and Family and Community Medicine and the Center for Evaluative and Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Department of Critical Care Medicine, Catholic Medical Center, Manchester, New Hampshire, USA
Division of Cardiology, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA
|| Cardiac Catheterization Laboratories, Elliot Hospital, Manchester, New Hampshire, USA
¶ Division of Cardiology, Eastern Maine Medical Center, Bangor, Maine, USA
# Division of Cardiology, Fletcher Allen Health Care, Burlington, Vermont, USA
Manuscript received December 31, 1998; revised manuscript received March 25, 1999, accepted May 10, 1999.
Reprint requests and correspondence: Dr. Paul D. McGrath, Center for Outcomes Research and Evaluation, Maine Medical Center, 22 Bramhall Street, Portland, Maine 04102.
mcgrap{at}mail.mmc.org
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.
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