Document Detail


Recent changes in practice of elective percutaneous coronary intervention for stable angina.
MedLine Citation:
PMID:  21505155     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial was designed to compare optimal medical therapy alone versus optimal medical therapy and percutaneous coronary intervention (PCI) for treatment of patients with stable coronary artery disease and showed equal efficacy for optimal medical therapy with or without PCI. The impact of results from the COURAGE trial on clinical practice is unknown.
METHODS AND RESULTS: We analyzed 26 388 consecutive patients from the Northern New England Cardiovascular Disease PCI Registry who underwent PCI between January 2006 and June 2009. We identified a COURAGE-like patient group as patients who were undergoing (1) an elective procedure; (2) for an indication of stable angina; and (3) on the day of admission (ie, the date of admission was the same as the procedure date). All other PCI patients were placed in an "other indications" cohort. We compared temporal trends in overall volume in PCI for stable angina and for other indications, comparing quarterly time periods before and after release of COURAGE in March 2007. Over the study period, there was a statistically significant decrease in total PCI volume from 2064 in Quarter 1 2006 (before COURAGE) to 1708 in Quarter 3 2007 (after COURAGE) (P<0.01). These trends were sustained through June 2009, with an approximate 16% peak relative reduction in all PCI compared with before COURAGE. As a percentage of all PCI, stable angina reached a high of 20.9% before COURAGE and began to decrease immediately after publication of COURAGE in Quarter 2 2007 to 16.1% (P<0.01). Among patients undergoing PCI for stable angina, there was a significant 26% peak decrease in post-COURAGE PCI volumes compared with pre-COURAGE Quarter 1 2006 (P trend, 0.01), which was maintained through the end of the study period.
CONCLUSIONS: Publication of results from the COURAGE trial was temporally associated with a significant and sustained decline in the use of PCI to treat patients with stable angina. The long-term impact of this change in practice on patient outcomes remains to be determined.
Authors:
Bina Ahmed; Harold L Dauerman; Winthrop D Piper; John F Robb; M Peter Verlee; Thomas J Ryan; David Goldberg; Richard A Boss; William J Phillips; Frank Fedele; David Butzel; David J Malenka;
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Publication Detail:
Type:  Journal Article     Date:  2011-04-19
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  4     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-18     Completed Date:  2011-09-30     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  300-5     Citation Subset:  IM    
Affiliation:
Division of Cardiology, University of New Mexico, Albuquerque, NM 87131, USA. bahmed@salud.unm.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angina Pectoris / therapy*
Angioplasty, Balloon, Coronary / trends*
Evidence-Based Medicine
Female
Humans
Male
Middle Aged
New England
Physician's Practice Patterns / trends*
Registries
Retrospective Studies
Treatment Outcome
Comments/Corrections
Comment In:
Circ Cardiovasc Qual Outcomes. 2011 May;4(3):263-5   [PMID:  21586723 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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