Trend in percutaneous coronary intervention volume following the COURAGE and BARI-2D trials: Insight from over 8.1 million percutaneous coronary interventions

Sripal Bangalore, Navdeep Gupta, Philippe Genereux, Yu Guo, Samir Pancholy, Frederick Feit

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Abstract Background COURAGE and BARI-2D have questioned the utility of routine revascularization for the prevention of cardiovascular events in patients with stable ischemic heart disease (SIHD). On the other end of the spectrum, a routine invasive strategy in patients with acute coronary syndrome (ACS) is superior to a conservative strategy. The impact of the above trials on the trend in percutaneous coronary intervention (PCI) volume for SIHD and ACS is not known. Methods Data from the 2001-2011 Nationwide Inpatient Sample for discharges with PCI were used. The trend in PCI volume over time was analyzed, especially in relation to the COURAGE (2007) and the BARI-2D (2009) trials. Age and gender adjusted PCI rates were calculated using direct standardization method. Results Among the 8,150,764 PCI procedures, there was a steady increase in PCI volumes until the publication of the COURAGE/BARI-2D trials after which the volume decreased. Compared to the peak volume of 909,331 in 2006, PCI volume declined by 38% to 562,036 in 2011 (P < 0.0001); driven by a 60% decrease in PCI for SIHD from 409,199 in 2006 to 160,707 in 2011 (P < 0.0001). Moreover, there was a 20% decrease in PCI for ACS from 500,132 in 2006 to 401,330 in 2011 (P < 0.0001) driven by a significant decrease in PCI for unstable angina. Results were similar in diabetics with a decline in the volume after BARI-2D trial, although the decline was less dramatic. Conclusion The 11-year trend indicates a substantial impact of COURAGE/BARI-2D on SIHD PCI volumes with an unintended consequence of lower PCI volumes for ACS.

Original languageEnglish (US)
Article number19614
Pages (from-to)6-10
Number of pages5
JournalInternational Journal of Cardiology
Volume183
DOIs
StatePublished - Mar 15 2015
Externally publishedYes

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
Myocardial Ischemia
Unstable Angina
Publications
Inpatients

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{eb4525d6d5cd48a59c4a4afcabd6fe4b,
title = "Trend in percutaneous coronary intervention volume following the COURAGE and BARI-2D trials: Insight from over 8.1 million percutaneous coronary interventions",
abstract = "Abstract Background COURAGE and BARI-2D have questioned the utility of routine revascularization for the prevention of cardiovascular events in patients with stable ischemic heart disease (SIHD). On the other end of the spectrum, a routine invasive strategy in patients with acute coronary syndrome (ACS) is superior to a conservative strategy. The impact of the above trials on the trend in percutaneous coronary intervention (PCI) volume for SIHD and ACS is not known. Methods Data from the 2001-2011 Nationwide Inpatient Sample for discharges with PCI were used. The trend in PCI volume over time was analyzed, especially in relation to the COURAGE (2007) and the BARI-2D (2009) trials. Age and gender adjusted PCI rates were calculated using direct standardization method. Results Among the 8,150,764 PCI procedures, there was a steady increase in PCI volumes until the publication of the COURAGE/BARI-2D trials after which the volume decreased. Compared to the peak volume of 909,331 in 2006, PCI volume declined by 38{\%} to 562,036 in 2011 (P < 0.0001); driven by a 60{\%} decrease in PCI for SIHD from 409,199 in 2006 to 160,707 in 2011 (P < 0.0001). Moreover, there was a 20{\%} decrease in PCI for ACS from 500,132 in 2006 to 401,330 in 2011 (P < 0.0001) driven by a significant decrease in PCI for unstable angina. Results were similar in diabetics with a decline in the volume after BARI-2D trial, although the decline was less dramatic. Conclusion The 11-year trend indicates a substantial impact of COURAGE/BARI-2D on SIHD PCI volumes with an unintended consequence of lower PCI volumes for ACS.",
author = "Sripal Bangalore and Navdeep Gupta and Philippe Genereux and Yu Guo and Samir Pancholy and Frederick Feit",
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Trend in percutaneous coronary intervention volume following the COURAGE and BARI-2D trials : Insight from over 8.1 million percutaneous coronary interventions. / Bangalore, Sripal; Gupta, Navdeep; Genereux, Philippe; Guo, Yu; Pancholy, Samir; Feit, Frederick.

In: International Journal of Cardiology, Vol. 183, 19614, 15.03.2015, p. 6-10.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Trend in percutaneous coronary intervention volume following the COURAGE and BARI-2D trials

T2 - Insight from over 8.1 million percutaneous coronary interventions

AU - Bangalore, Sripal

AU - Gupta, Navdeep

AU - Genereux, Philippe

AU - Guo, Yu

AU - Pancholy, Samir

AU - Feit, Frederick

PY - 2015/3/15

Y1 - 2015/3/15

N2 - Abstract Background COURAGE and BARI-2D have questioned the utility of routine revascularization for the prevention of cardiovascular events in patients with stable ischemic heart disease (SIHD). On the other end of the spectrum, a routine invasive strategy in patients with acute coronary syndrome (ACS) is superior to a conservative strategy. The impact of the above trials on the trend in percutaneous coronary intervention (PCI) volume for SIHD and ACS is not known. Methods Data from the 2001-2011 Nationwide Inpatient Sample for discharges with PCI were used. The trend in PCI volume over time was analyzed, especially in relation to the COURAGE (2007) and the BARI-2D (2009) trials. Age and gender adjusted PCI rates were calculated using direct standardization method. Results Among the 8,150,764 PCI procedures, there was a steady increase in PCI volumes until the publication of the COURAGE/BARI-2D trials after which the volume decreased. Compared to the peak volume of 909,331 in 2006, PCI volume declined by 38% to 562,036 in 2011 (P < 0.0001); driven by a 60% decrease in PCI for SIHD from 409,199 in 2006 to 160,707 in 2011 (P < 0.0001). Moreover, there was a 20% decrease in PCI for ACS from 500,132 in 2006 to 401,330 in 2011 (P < 0.0001) driven by a significant decrease in PCI for unstable angina. Results were similar in diabetics with a decline in the volume after BARI-2D trial, although the decline was less dramatic. Conclusion The 11-year trend indicates a substantial impact of COURAGE/BARI-2D on SIHD PCI volumes with an unintended consequence of lower PCI volumes for ACS.

AB - Abstract Background COURAGE and BARI-2D have questioned the utility of routine revascularization for the prevention of cardiovascular events in patients with stable ischemic heart disease (SIHD). On the other end of the spectrum, a routine invasive strategy in patients with acute coronary syndrome (ACS) is superior to a conservative strategy. The impact of the above trials on the trend in percutaneous coronary intervention (PCI) volume for SIHD and ACS is not known. Methods Data from the 2001-2011 Nationwide Inpatient Sample for discharges with PCI were used. The trend in PCI volume over time was analyzed, especially in relation to the COURAGE (2007) and the BARI-2D (2009) trials. Age and gender adjusted PCI rates were calculated using direct standardization method. Results Among the 8,150,764 PCI procedures, there was a steady increase in PCI volumes until the publication of the COURAGE/BARI-2D trials after which the volume decreased. Compared to the peak volume of 909,331 in 2006, PCI volume declined by 38% to 562,036 in 2011 (P < 0.0001); driven by a 60% decrease in PCI for SIHD from 409,199 in 2006 to 160,707 in 2011 (P < 0.0001). Moreover, there was a 20% decrease in PCI for ACS from 500,132 in 2006 to 401,330 in 2011 (P < 0.0001) driven by a significant decrease in PCI for unstable angina. Results were similar in diabetics with a decline in the volume after BARI-2D trial, although the decline was less dramatic. Conclusion The 11-year trend indicates a substantial impact of COURAGE/BARI-2D on SIHD PCI volumes with an unintended consequence of lower PCI volumes for ACS.

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