Evolving trends in interventional device use and outcomes: Results from the National Cardiovascular Network database

Background Although multiple new coronary interventional devices have been approved for marketing in the United States, use of these technologies in g eneral clinical practice and their associated outcomes have not been report ed. Methods and Results Using the National Cardiovascular Network's Coronary In terventional Database, we examined temporal trends in the use and outcomes of coronary stents, lasers, directional atherectomy, and rotational atherec tomy devices at 12 US hospitals between January 1994 and December 1997 (n = 76,904). Over this period, the percentage of cases involving coronary sten ts rose more than 12-fold (from 5.4% in 1994 to 69.0% in 1997). In contrast , use of atherectomy-type devices declined significantly. Device selection was strongly influenced by the patient's coronary anatomy and procedural in dication, but less by age, sex, or race. Device use also varied significant ly among individual centers (4-fold variation among sites in stent use and 6-fold variation in atherectomy use) even after adjusting for patient chara cteristics. Although overall mortality rates were unchanged during this 4-y ear period, procedural success rates have improved and complication rates h ave declined significantly. lengths of postprocedure hospital stay also fel l significantly for all patients undergoing coronary intervention in this t ime period. Conclusions Percutaneous interventional strategies are rapidly changing wit h the explosive growth of coronary stent use and the decline in use of athe rectomy devices. Patient outcomes, including complication rates and postpro cedure lengths of stay, have also improved as the new interventional strate gies have been refined in clinical practice.