Published Online
on December 15, 2008

A more recent version of this article appeared on February 1, 2009

This Article Full Text (PDF) Data Supplement All Versions of this Article: 2/1/6    most recent CIRCINTERVENTIONS.108.825323v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Venkitachalam, L. Articles by Kelsey, S. F. Search for Related Content PubMed Articles by Venkitachalam, L. Articles by Kelsey, S. F. Related Collections Epidemiology Catheter-based coronary interventions: stents Related Articles

Original Article

Twenty-year evolution of Percutaneous coronary intervention and its impact on clinical outcomes — a report from the NHLBI-sponsored, multicenter 1985-86 PTCA and 1997-2006 Dynamic Registries

Lakshmi Venkitachalam^1,9; Kevin E. Kip²; Faith Selzer³; Robert L. Wilensky⁴; James Slater⁵; Suresh R. Mulukutla⁶; Oscar C. Marroquin⁶; Peter C. Block⁷; David O. Williams⁸ and Sheryl F. Kelsey³

¹ University of Pittsburgh Medical Center and University of Pittsburgh, Pittsburgh, PA;
² University of South Florida,Tampa, FL;
³ University of Pittsburgh, Pittsburgh, PA;
⁴ University of Pennsylvania, Philadelphia, PA;
⁵ New York University Medical Center, New York, NY;
⁶ University of Pittsburgh Medical Center, Pittsburgh, PA;
⁷ Emory University Hospital, Atlanta, GA;
⁸ Brown University, Providence, RI

⁹ E-mail: venkitachalaml{at}upmc.edu

Background—Percutaneous coronary intervention has undergone rapid progress both in technology and adjunct therapy. However, documentation of long-term temporal trends in relation to contemporary practice is lacking.

Methods and Results—We analyzed PCI use and outcomes in 8976 consecutive patients in the multicenter NHLBI-sponsored 1985-86 PTCA and 1997-2006 Dynamic Registries waves [wave 1: 1997-98, bare metal stents; wave 2: 1999, uniform use of stents; wave 3: 2001-02, brachytherapy; waves 4 and 5: 2004-2006,drug-eluting stents]. Patients undergoing PCI in the recent waves were older and more often reported comorbidities than those in the balloon era. PCI was more often performed for acute coronary syndromes and, in spite of the greater disease burden, was more often selective. Procedural success was achieved and maintained more often in the stent era. Significant reductions were observed in in-hospital rates (%) of myocardial infarction (PTCA Registry: 4.9, wave 1: 2.7, wave 2: 2.8, wave 3: 1.9, wave 4: 2.6, wave 5: 2, P_trend:<0.001) and emergency CABG (PTCA Registry: 3.7, wave 1: 0.4, wave 2: 0.4, wave 3: 0.3, wave 4: 0.4, wave 5: 0, P_trend:<0.001). Compared to the PTCA Registry, risk for repeat revascularization (31-365 days following index PCI) was significantly lower in the Dynamic waves (adjusted hazard ratio, wave 1: 0.72, wave 2: 0.51, wave 3: 0.51, wave 4: 0.30, wave 5: 0.36; P< 0.05 for all).

Conclusion—Percutaneous interventions, in the last two decades, has evolved to include more urgent, comorbid cases, yet achieving high success rates with significantly reduced need for repeat revascularization.

Key Words: angioplasty • registries • stents • temporal trends

Related Articles

The First Generation of Angioplasty

William W. O'Neill and Brian P. O'Neill
Circ Cardiovasc Interv 2009 2: 1-3. [Extract] [Full Text] [PDF]

Twenty-Year Evolution of Percutaneous Coronary Intervention and Its Impact on Clinical Outcomes: A Report From the National Heart, Lung, and Blood Institute–Sponsored, Multicenter 1985–1986 PTCA and 1997–2006 Dynamic Registries

Lakshmi Venkitachalam, Kevin E. Kip, Faith Selzer, Robert L. Wilensky, James Slater, Suresh R. Mulukutla, Oscar C. Marroquin, Peter C. Block, David O. Williams, Sheryl F. Kelsey for the Investigators of NHLBI-Sponsored 1985–1986 PTCA and 1997–2006 Dynamic Registries
Circ Cardiovasc Interv 2009 2: 6-13. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				J. B. Lindsey, S. P. Marso, M. Pencina, J. M. Stolker, K. F. Kennedy, C. Rihal, G. Barsness, R. N. Piana, S. L. Goldberg, D. E. Cutlip, et al. Prognostic Impact of Periprocedural Bleeding and Myocardial Infarction After Percutaneous Coronary Intervention in Unselected Patients: Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1074 - 1082. [Abstract] [Full Text] [PDF]