Population Trends in Percutaneous Coronary Intervention 20-Year Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
ABSTRACT OBJECTIVES: The aim of this study was to describe the characteristics and outcome of all consecutive patients treated with PCI in an unselected nation-wide cohort over the last 2 decades. BACKGROUND: Over the last 20 years, treatment with percutaneous coronary intervention (PCI) has evolved dramatically but the change in patient characteristics has not been well described. METHODS: We included all patients undergoing a PCI procedure for the first time between January 1990 and December 2010 from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Patients were divided in different cohorts based on the year of the first PCI procedure. RESULTS: A total of 144,039 patients were included. The mean age increased from 60.1 (SD±9.9) years in 1990-1995 to 67.1 (±11.2) years in 2009-2010. The proportion of patients presenting with unstable coronary artery disease and STEMI increased from 27.4% and 6.2% to 47.7% and 32.5% respectively. Diabetes and multivessel disease were more often present in the later year cohorts. The 1-year mortality increased from 2.2% in 1990-1995 to 5.9% in 2009-2010, but after adjustment for age and indication a modest decrease was shown, mainly in STEMI patients. CONCLUSIONS: Characteristics of PCI patients have changed substantially over time reflecting the establishment of new evidence. The increasing age and proportion of patients undergoing PCI for acute coronary syndromes greatly influence outcome. The understanding of the changing patient characteristics is important for the translation of evidence to real-world clinical practice.
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ABSTRACT: BACKGROUND: Technological developments have enabled the expansion of percutaneous coronary intervention (PCI) indications for more challenging clinical and angiographic scenarios. Our objective was to evaluate the results of PCI in two different periods in the past 6 years. METHODS: This was a multicenter registry including 6,288 consecutive patients treated by PCI, who were divided according to different treatment periods: 2006 to 2008 (P1; n = 1,779) and 2009 to 2012 (P2; n = 4,509). We intended to compare the rates of in-hospital major adverse cardiac and cerebrovascular events (MACCE) and identify their predictors. RESULTS: P2 patients were younger and had a higher prevalence of smoking and diabetes. These patients had a greater rate of multivessel, thrombotic and bifurcation lesions. The number of diseased vessels per patient was higher in the P2 Group, as well as the number of stents per patient, and the use of drug-eluting stents. MACCE was more frequent in P2 patients (2.5% vs. 3.5%; P = 0.04), due to periprocedural myocardial infarction (1.7% vs. 2.6%; P = 0.05), and there were no differences in terms of death (1.0% vs. 1.0%; P = 0.87), stroke (0.2% vs. 0.1%; P = 0.47) or emergency coronary artery bypass grafting (0.1% vs. 0; P = 0.68). Age (odds ratio - OR - 1.02; 95% confidence interval - CI 95% - 1.00-1.05; P = 0.04) and Killip III/IV (OR = 6.0, 95% CI; 3.3-10.9; P < 0.01) were the variables that best explained the presence of MACCE. CONCLUSIONS: In this large cohort, substancial changes occurred in the characteristics of patients treated by PCI in the last 6 years. This more complex scenario was associated to a slight increase of periprocedural myocardial infarctions, but not to other in-hospital clinical adverse events.12/2012; 21(3):258-264. DOI:10.1590/S2179-83972013000300011
- European Heart Journal 05/2013; 34(37). DOI:10.1093/eurheartj/eht177 · 14.72 Impact Factor
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ABSTRACT: Increased myocardial infarct (MI) size is associated with higher risk of developing left ventricular dysfunction, heart failure and mortality. Experimental studies have suggested that metformin treatment reduces MI size after induced ischaemia but human data is lacking. We aimed to investigate the effect of metformin on MI size in patients presenting with an acute MI. All consecutive patients (n = 3,288) presenting to our hospital with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI between January 2004 and December 2010 were included in this retrospective analysis. Patients with diabetes were divided according to metformin versus non-metformin based pharmacotherapy. MI size was estimated using peak values of serum creatine kinase (CK), myocardial band of CK (CK-MB), and troponin-T. We identified 677 (20.6 %) patients with diabetes, of whom 189 (27.9 %) were treated with metformin. Chronic metformin treatment was associated with lower peak levels of CK (1,101 vs. 1,422 U/L, P = 0.005), CK-MB (152 vs. 182 U/L, P = 0.018) and troponin-T (2.5 vs. 4.0 ng/L, P = 0.021) compared to non-metformin using diabetics. After adjustment for age, sex, TIMI flow post PCI, and previous MI, the use of metformin treatment remained an independent predictor of smaller MI size. Patient with diabetes treated with metformin had even smaller MI size than patients without diabetes. Chronic metformin treatment is associated with reduced MI size compared to non-metformin based strategies in diabetic patients presenting with STEMI. Metformin might have additional beneficial effects beyond glucose lowering efficacy.Cardiovascular Drugs and Therapy 12/2013; 34(suppl 1). DOI:10.1007/s10557-013-6504-7 · 2.95 Impact Factor