Faculty Collaboration Database

Changes in patterns of coronary revascularization strategies for patients with acute coronary syndromes (from the CRUSADE Quality Improvement Initiative). Am J Cardiol 2007 May 01;99(9):1222-6

Date

05/05/2007

Pubmed ID

17478146

DOI

10.1016/j.amjcard.2006.12.037

Scopus ID

2-s2.0-34247483103 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

Since the introduction of drug-eluting stents (DESs), patterns of revascularization strategies for patients with non-ST-segment elevation acute coronary syndromes have not been assessed. We studied 82,924 patients from the CRUSADE Initiative who presented with non-ST-segment elevation acute coronary syndromes and underwent coronary angiography at 365 United States hospitals that had capabilities for surgical (coronary artery bypass grafting [CABG]) and percutaneous (percutaneous coronary intervention [PCI]) revascularization from January 2002 to June 2005. Temporal trends in the use of PCI, CABG, and medical management without revascularization were analyzed with respect to the introduction of DESs. In total, 73,577 patients (89%) had >50% stenosis in > or =1 coronary artery, and there was a significant increase in the use of PCI (vs CABG or medical management without revascularization) during the study period (38.3% vs 52.5%). By quarter 2 of 2005, 80% of patients who underwent PCI received a DES. In total, 18,462 of 25,068 patients (73.6%) with 3-vessel disease (3VD) underwent revascularization and use of CABG decreased for these patients (48.9% to 39.9%, p <0.001), whereas use of PCI increased (51.1% to 60.1%, p <0.001). Factors significantly associated with use of PCI for patients with 3VD who underwent any revascularization included previous PCI, previous CABG, cardiology inpatient care, care at an academic hospital, renal insufficiency, and previous congestive heart failure. In conclusion, coinciding with the introduction of DESs, there has been a significant increase in the use of PCI and, in those patients with 3VD, a decrease in the use of CABG with a shift toward increasing use of PCI. Long-term implications of this shift remain uncertain, especially in patients with 3VD.

Author List

Gogo PB Jr, Dauerman HL, Mulgund J, Ohman EM, Patel MR, Cohen DJ, Saucedo JF, Harrington RA, Gibler WB, Smith SC Jr, Peterson ED, Roe MT, CRUSADE Investigators

Author

Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Angioplasty, Balloon, Coronary
Cardiovascular Agents
Coronary Artery Bypass
Coronary Disease
Databases, Factual
Female
Humans
Male
Middle Aged
Patient Selection
Retrospective Studies
Risk Factors
Stents
Syndrome
United States