Improving outcome over time of percutaneous coronary interventions in unstable angina

OBJECTIVE This study was performed to evaluate the recent changes in the in terventions in patients with unstable angina (UA). BACKGROUND An early invasive strategy has not been shown to be superior to conservative treatment in patients with UA. Earlier studies had utilized ol der technology. Interventional approaches have changed in the recent past, but to our knowledge, no large studies have addressed the impact of these c hanges on the outcome of coronary interventions. METHODS We analyzed the in-hospital and intermediate-term outcome in 7,632 patients with UA who underwent coronary interventions in the last two decad es. The study population was divided into three groups: group 1, n = 2,209 who had coronary intervention from 1979 to 1989; group 2, n = 2,212 with in terventions from 1990 to 1993; and group 3, n = 3,211 treated from 1994 to 1998. RESULTS Group 2 and 3 patients were older and sicker compared with group 1 patients. The clinical success improved significantly in group 3 (94.1%) co mpared with group 2 (87%) and group 1 (76.5%) (p < 0.001). There was a sign ificant reduction in in-hospital mortality, Q- wave myocardial infarction a nd need for emergency bypass surgery in group 3 compared with the earlier g roups. One-year event-free survival was also significantly higher in the re cent group compared with the earlier groups: 77% in group 3, 70% in group 2 and 74% in group 1 (p < 0.001). With the use of multivariate models to adj ust for clinical and angiographic variables, treatment during the most rece nt era was found to be independently associated with improved in-hospital a nd intermediate-term outcomes. CONCLUSIONS There has been significant improvement in the in hospital and i ntermediate-term outcome of coronary interventions in patients with UA in r ecent years; newer trials comparing conservative and invasive strategies ar e therefore needed. (J Am Coll Cardiol 2000;36: 674-8) (c) 2000 by the Amer ican College of Cardiology