Changing outcomes in percutaneous coronary interventions - A study of 34,752 procedures in Northern New England, 1990 to 1997

OBJECTIVES We sought to evaluate the changing outcomes of percutaneous coro nary interventions (PCIs) in recent years. BACKGROUND The field of interventional cardiology has seen considerable gro wth in recent years, both in the number of patients undergoing procedures a nd in the development of new technology. In view of recent changes, we eval uated the experience of a large, regional registry of PCIs and outcomes ove r time. METHODS Data were collected from 1990 to 1997 on 34,752 consecutive PCIs pe rformed at all hospitals in Maine (two), New Hampshire (two) and Vermont to ne) supporting these procedures, and one hospital in Massachusetts. Univari ate and multivariate regression analyses were used to control for case mix. Clinical success was defined as at least one lesion dilated to <50% residu al stenosis and no adverse outcomes. In-hospital adverse outcomes included coronary artery bypass graft surgery (CABG), myocardial infarction and mort ality. RESULTS Over time, the population undergoing PCIs tended to be older with i ncreasing comorbidity. After adjustment for case mix, clinical success cont inued 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 i n recent years from a peak of 2.3% to 1.3% (p trend <0.001). Mortality rate s decreased slightly from 1.20/0 to 1.1% (p trend 0.007). CONCLUSIONS There has been a significant improvement in clinical outcomes f or patients undergoing PCIs in northern New England, including a significan t decline in the need for emergency CABG. (J Am Coll Cardiol 1999;34:674-80 ) (C) 1999 by the American College of Cardiology.