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Temporal changes in the use of drug-eluting stents for patients with non-ST-Segment-elevation myocardial infarction undergoing percutaneous coronary intervention from 2006 to 2008: results from the can rapid risk stratification of unstable angina patients supress ADverse outcomes with early implementation of the ACC/AHA guidelines (CRUSADE) and acute coronary treatment and intervention outcomes network-get with the guidelines (ACTION-GWTG) registries.
- Source :
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Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2009 Sep; Vol. 2 (5), pp. 414-20. Date of Electronic Publication: 2009 Jul 28. - Publication Year :
- 2009
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Abstract
- Background: The risks of late stent thrombosis with drug-eluting stents (DES) were intensely debated after the presentation of a number of studies highlighting this issue in September 2006. We evaluated trends in the use of DES for patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) from 2006 to 2008.<br />Methods and Results: Temporal patterns of DES use were examined among non-ST-elevation myocardial infarction patients in the Can Rapid risk stratification of Unstable angina patients Supress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE; January 2006 to December 2006) and Acute Coronary Treatment and Intervention Outcomes Network-Get With The Guidelines (ACTION-GWTG; January 2007 to June 2008) registries to determine how practice patterns changed for patients with acute myocardial infarction undergoing PCI. Among the 54 662 patients analyzed, the percentage of patients undergoing PCI by quarter varied from 54% to 58% during the analysis time period. More than 90% of patients undergoing PCI received a DES in the first 3 quarters of 2006 before the public debate about the risks of DES began. Thereafter, the use of DES for PCI patients declined during the fourth quarter of 2006 through the first quarter of 2007 (82% to 67%), gradually declined during quarters 2 to 4 of 2007 (63% to 63% to 59%) but then slightly increased from the first to second quarter of 2008 (58% to 60%). Hospital characteristics did not seem to correlate with temporal changes in DES use, but by the last 2 quarters of the study period, patient characteristics such as white race, hypertension, diabetes mellitus, and private or managed care insurance were more common among patients who received a DES compared with the beginning 2 quarters of the study period.<br />Conclusions: These findings highlight how rapidly treatment decisions in contemporary practice can be affected by public debate related to scientific presentations and publications.
- Subjects :
- Aged
American Heart Association
Angina, Unstable diagnosis
Angioplasty, Balloon, Coronary statistics & numerical data
Drug-Eluting Stents trends
Electrocardiography
Female
Hospitals statistics & numerical data
Humans
Male
Middle Aged
Myocardial Infarction diagnosis
Practice Guidelines as Topic
Practice Patterns, Physicians' statistics & numerical data
Registries
Risk Factors
United States
Angina, Unstable mortality
Angina, Unstable therapy
Angioplasty, Balloon, Coronary mortality
Drug-Eluting Stents statistics & numerical data
Myocardial Infarction mortality
Myocardial Infarction therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 2
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 20031871
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.109.850248