Changes in the practice of percutaneous coronary intervention: A comparison of enrollment waves in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry
Wk. Laskey et al., Changes in the practice of percutaneous coronary intervention: A comparison of enrollment waves in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry, AM J CARD, 87(8), 2001, pp. 964-969
Citations number
14
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
The National Heart, Lung, and Blood Institute Dynamic Registry includes 15
clinical sites in wave 1, and 16 sites in wave 2 as well as a date-coordina
ting center. The first wave of enrollment began in July 1997 and was comple
ted in February 1998. The second wave began in February 1999 and ended in J
une 1999. There were a total of 2,526 patients in wave 1 and 2,109 patients
in wave 2. Comprehensive pre-, intra-, and postprocedure (in-hospital) dat
a were analyzed for changes between recruitment waves. Patients in wave 2 w
ere more frequently nonwhite (p less than or equal to0.001), hypertensive b
y history (p less than or equal to0.001), had more significant noncardiac c
omorbidity (p less than or equal to0.01), and had more frequently undergone
prior percutaneous coronary intervention (p <0.05). Patients in wove 2 und
erwent percutaneous coronary intervention in a setting of acute coronary sy
ndromes more frequently than wave 1 patients (p <less than or equal to>0.00
1). However, most interventions in both waves were performed on 1 vessel, i
rrespective of the extent of disease. Attempted lesions in wave 2 were long
er (p less than or equal to0.001), less frequently totally occluded (p less
than or equal to0.001), and more frequently in vessels with a prior stent
(p less than or equal to0.01). Using the American Heart Association/America
n College of Cardiology lesion classification scheme, attempted lesions in
wave 2 were less complex than those in wave 1 (p less than or equal to0.001
). Stent use increased significantly from wave 1 (67%) to wave 2 (79%, p le
ss than or equal to0.001) as did the use of platelet glycoprotein IIb/IIIa
antagonists (wave 1, 24%; wave 2, 32%: p <0.001). Procedural outcomes (angi
ographic success without major in-hospital adverse events) were excellent i
n both waves 1 (94.6%) and 2 (95.6%) and were not significantly different.
However, the frequency of significant procedural coronary dissection and in
- and out-of-laboratory abrupt closure were significantly less in wave 2 (p
<less than or equal to>0.001) Discharge medications were more likely to in
clude angiotensin-converting enzyme inhibitors, p-adrenergic blocking agent
s, and hypolipidemic treatment in wave 2 than in wave 1 (p less than or equ
al to0.001). These data indicate a continuing aggressive approach to patien
t care over the time interval analyzed. Although overall procedural outcome
s are excellent, procedural safety has been further enhanced. There is also
a growing awareness of the importance of secondary prevention among interv
entional cardiologists. (C) 2001 by Excerpta Medica, Inc.