CLINICAL STUDIES
Changing outcomes in percutaneous coronary interventions
A study of 34,752 procedures in Northern New England, 1990 to 1997
Paul D. McGrath, MD, MSc, FACC*,
David J. Malenka, MD, FACC ,
David E. Wennberg, MD, MPH* ,
Samuel J. Shubrooks, Jr., MD, FACC ,
William A. Bradley, MD, FACC ,
John F. Robb, MD, FACC,
Mirle A. Kellett, Jr., MD, FACC*,
Thomas J. Ryan, Jr., MD, FACC*,
Michael J. Hearne, MD, FACC||,
Bruce Hettleman, MD, FACC,
John R. O’Meara, MD, FACC*,
Peter VerLee, MD, FACC¶,
Matthew W. Watkins, MD, FACC#,
Winthrop D. Piper, MSc,
Gerald T. O’Connor, PhD, DSc, FACC for the Northern New England Cardiovascular Disease Study Group**
* 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.
|
Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CPK | = creatine phosphokinase | | DCA | = directional coronary atherectomy | | EF | = ejection fraction | | IABP | = intraaortic balloon pump | | LAD | = left anterior descending coronary artery | | MI | = myocardial infarction | | NNECVDSG | = Northern New England Cardiovascular Disease Study Group | | PCI | = percutaneous coronary intervention |
|
This article has been cited by other articles:
|
|
|
|
 
J M Wilson
Diagnosis and treatment of acquired coronary artery disease in adults
Postgrad. Med. J.,
July 1, 2009;
85(1005):
364 - 365.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Kunadian, J. Dunning, A. P Roberts, R. Morley, D. Twomey, J. A Hall, A. G C Sutton, R. A Wright, D. F Muir, and M. A d. Belder
Cumulative funnel plots for the early detection of interoperator variation: retrospective database analysis of observed versus predicted results of percutaneous coronary intervention
BMJ,
April 26, 2008;
336(7650):
931 - 934.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes Jr, B. J. Gersh, P. Whitlow, S. B. King III, and J. T. Dove
Percutaneous coronary intervention for chronic stable angina a reassessment.
J. Am. Coll. Cardiol. Intv.,
February 1, 2008;
1(1):
34 - 43.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Wilson and J. T. Willerson
Myocardial Revascularization with Percutaneous Devices
Card. Surg. Adult,
January 1, 2008;
3(2008):
573 - 598.
[Full Text]
|
|
|
|
|
|
|
S. B. King III, T. Aversano, W. L. Ballard, R. H. Beekman III, M. J. Cowley, S. G. Ellis, D. P. Faxon, E. L. Hannan, J. W. Hirshfeld Jr, A. K. Jacobs, et al.
ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures)
J. Am. Coll. Cardiol.,
July 3, 2007;
50(1):
82 - 108.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Singh, C. S. Rihal, B. J. Gersh, R. J. Lennon, A. Prasad, P. Sorajja, R. E. Gullerud, and D. R. Holmes Jr
Twenty-Five-Year Trends in In-Hospital and Long-Term Outcome After Percutaneous Coronary Intervention: A Single-Institution Experience
Circulation,
June 5, 2007;
115(22):
2835 - 2841.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Waikar, G. C. Curhan, R. Wald, E. P. McCarthy, and G. M. Chertow
Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002
J. Am. Soc. Nephrol.,
April 1, 2006;
17(4):
1143 - 1150.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Baim, R. Mehran, D. J. Kereiakes, T. P. Gross, M. Simons, D. Malenka, and A. V. Kaplan
Postmarket Surveillance for Drug-Eluting Coronary Stents: A Comprehensive Approach
Circulation,
February 14, 2006;
113(6):
891 - 897.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Moscucci, E. K. Rogers, C. Montoye, D. E. Smith, D. Share, M. O'Donnell, A. Maxwell-Eward, W. L. Meengs, A. C. De Franco, K. Patel, et al.
Association of a Continuous Quality Improvement Initiative With Practice and Outcome Variations of Contemporary Percutaneous Coronary Interventions
Circulation,
February 14, 2006;
113(6):
814 - 822.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. S. Weintraub
Evaluating the Risk of Coronary Surgery and Percutaneous Coronary Intervention
J. Am. Coll. Cardiol.,
February 7, 2006;
47(3):
669 - 671.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Batyraliev, M. R. Ayalp, A. Sercelik, Z. Karben, G. Dinler, F. Besnili, S. Ozgul, and I. Perchucov
Complications of Cardiac Catheterization: A Single-Center Study
Angiology,
January 1, 2005;
56(1):
75 - 80.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. S. Resnic, K. H. Zou, D. V. Do, G. Apostolakis, and L. Ohno-Machado
Exploration of a Bayesian Updating Methodology to Monitor the Safety of Interventional Cardiovascular Procedures
Med Decis Making,
August 1, 2004;
24(4):
399 - 407.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. L. Benza, G. J. Zoghbi, J. Tallaj, R. Brown, J. K. Kirklin, M. Hubbard, B. Rayburn, B. Foley, D. C. McGiffin, L. J. Pinderski, et al.
Palliation of allograft vasculopathy with transluminal angioplasty: A decade of experience
J. Am. Coll. Cardiol.,
June 2, 2004;
43(11):
1973 - 1981.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes Jr
Risk Stratification and Interventional Cardiology: Robert L. Frye Lecture
Mayo Clin. Proc.,
December 1, 2003;
78(12):
1507 - 1518.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. N. Levine, M. J. Kern, P. B. Berger, D. L. Brown, L. W. Klein, D. J. Kereiakes, T. A. Sanborn, A. K. Jacobs, and for the American Heart Association Diagnostic and
Management of Patients Undergoing Percutaneous Coronary Revascularization
Ann Intern Med,
July 15, 2003;
139(2):
123 - 136.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes, F. Selzer, J. M. Johnston, S. F. Kelsey, R. Holubkov, H. A. Cohen, D. O. Williams, and K. M. Detre
Modeling and Risk Prediction in the Current Era of Interventional Cardiology: A Report From the National Heart, Lung, and Blood Institute Dynamic Registry
Circulation,
April 15, 2003;
107(14):
1871 - 1876.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. L Williams, A. Vazir, and A. G Zaman
Review: The management of stable angina in diabetes
The British Journal of Diabetes & Vascular Disease,
January 1, 2003;
3(1):
18 - 25.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. Singh, R. J. Lennon, D. R. Holmes Jr, M. R. Bell, and C. S. Rihal
Correlates of procedural complicationsand a simple integer risk scorefor percutaneous coronary intervention
J. Am. Coll. Cardiol.,
August 7, 2002;
40(3):
387 - 393.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Singh, H. H. Ting, P. B. Berger, K. N. Garratt, D. R. Holmes Jr, and B. J. Gersh
Rationale for on-site cardiac surgery for primary angioplasty: a time for reappraisal
J. Am. Coll. Cardiol.,
June 19, 2002;
39(12):
1881 - 1889.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. E. Shaw, H. V. Anderson, R. G. Brindis, R. J. Krone, L. W. Klein, C. R. McKay, P. C. Block, L. J. Shaw, K. Hewitt, W. S. Weintraub, et al.
Development of a risk adjustment mortality model using the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) experience: 1998-2000
J. Am. Coll. Cardiol.,
April 3, 2002;
39(7):
1104 - 1112.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Hlatky and R. A. Dudley
Operator Volume and Clinical Outcomes of Primary Coronary Angioplasty for Patients With Acute Myocardial Infarction
Circulation,
October 30, 2001;
104(18):
2155 - 2157.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Moscucci, E. Kline-Rogers, D. Share, M. O'Donnell, A. Maxwell-Eward, W. L. Meengs, P. Kraft, A. C. DeFranco, J. L. Chambers, K. Patel, et al.
Simple Bedside Additive Tool for Prediction of In-Hospital Mortality After Percutaneous Coronary Interventions
Circulation,
July 17, 2001;
104(3):
263 - 268.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cronin, S. R. Mehta, F. Zhao, J. Pogue, A. Budaj, D. Hunt, and S. Yusuf
Stroke in Relation to Cardiac Procedures in Patients With Non-ST-Elevation Acute Coronary Syndrome: A Study Involving >18 000 Patients
Circulation,
July 17, 2001;
104(3):
269 - 274.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al.
ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions
J. Am. Coll. Cardiol.,
June 15, 2001;
37(8):
2239 - 2239.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. van Royen, J. J. Piek, I. Buschmann, I. Hoefer, M. Voskuil, and W. Schaper
Stimulation of arteriogenesis; a new concept for the treatment of arterial occlusive disease
Cardiovasc Res,
February 16, 2001;
49(3):
543 - 553.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. D. McGrath, D. E. Wennberg, J. D. Dickens Jr, A. E. Siewers, F. L. Lucas, D. J. Malenka, M. A. Kellett Jr, and T. J. Ryan Jr
Relation Between Operator and Hospital Volume and Outcomes Following Percutaneous Coronary Interventions in the Era of the Coronary Stent
JAMA,
December 27, 2000;
284(24):
3139 - 3144.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L.K. Michalis, C.S. Stroumbis, K. Pappas, E. Sourla, D. Niokou, J.A. Goudevenos, C. Siogas, and D.A. Sideris
Treatment of Refractory Unstable angina in geographically isolated areas without Cardiac Surgery. Invasive versus conservative strategy (TRUCS Study)
Eur. Heart J.,
December 1, 2000;
21(23):
1954 - 1959.
[Abstract]
[PDF]
|
|
|
|
