Temporal trends in percutaneous coronary intervention outcomes among older patients in the United States

Abstract

Background New percutaneous coronary intervention (PCI) device technologies are often rapidly adopted into clinical practice, yet few studies have examined the overall impact of these new technologies on patient outcomes in community practice. Methods In hopes of determining temporal trends in PCI outcomes, we used data from the Centers for Medicare & Medicaid Service's Chronic Condition Warehouse (n = 3,250,836) by comparing patient characteristics and rates of 3-year major adverse cardiac events (MACE) across the balloon angioplasty (POBA) era (01/1991-09/1995), the bare metal stent (BMS) era (02/1998-04/2003), and the drug-eluting stent (DES) era (05/2004-10/2006). The adjusted association between era and outcomes was determined with Cox proportional hazards modeling (POBA era as reference). Results Compared with the POBA era, patients undergoing PCI were significantly older and had more medical comorbidities, and the risk for 3-year MACE was significantly lower during the BMS and DES eras (BMS vs. POBA adjusted HR [95% CI]: 0.930 [0.926–0.935]; DES vs. BMS: 0.831 [0.827–0.835]). Compared with males, the adjusted risk for 3-year MACE among females was lower during the POBA era, but slightly higher during the BMS and DES eras. Across all three eras, patients ≥75 years of age had higher adjusted risk for MACE compared with younger patients, and the risk for revascularization was lower for both females and older patients. Conclusions Despite its application in older and sicker Medicare beneficiaries, there has been a significant decrease in post-PCI MACE over time. The risk for death or myocardial infarction is higher among females and older patients compared with males and younger patients; therefore, future studies should focus on improving clinical outcomes in these high-risk subgroups.

Temporal Trends in Clinical Outcome After Percutaneous Coronary Intervention 1984–2010 – Report From the Juntendo PCI Registry –

“…Rao et al examined a temporal trend in the clinical outcome after PCI from 1991 to 2006 in a large cohort of Medicare beneficiaries. 12 In that study, a significant decrease in long-term clinical outcomes including death, MI and repeat revascularization was found. Patient background was unfavorable in the recent era of that study period, which was observed in the present study as well.…”

Protective effect of proanthocyanidins on anoxia-reoxygenation injury of myocardial cells mediated by the PI3K/Akt/GSK-3β pathway and mitochondrial ATP-sensitive potassium channel

“…The early, continuous and full opening of infarct-associated vessels to recover blood perfusion in the ischemic myocardium is the most important principle of treatment for AMI. In recent years, with the wide application of intravenous thrombolysis, percutaneous coronary interventions (PCI), coronary artery bypass grafting and other strategies, there has been an evident improvement in the symptoms and prognosis for patients with coronary heart disease and AMI (3). However, despite the numerous strategies available, it is common that clinical symptoms do not improve as expected.…”

“…The experiment was started when the myocardial cells grew close to conf luence, exhibiting synchronous growth cycles. Ischemia simulation solution components included NaH 2 PO 4 0.9 m mol/l, NaHCO 3 Trial grouping. The present study was divided into five groups according to an experimental scheme.…”

CASE 11—2016 Perioperative Coronary Thrombosis in a Patient With Multiple Second-Generation Drug-Eluting Stents: Is It Time for a Paradigm Shift?

“…48 This has resulted in steady improvements in procedural and longerterm efficacy and safety across the spectrum of clinical presentation and risk. 52 In particular, two developments have revolutionized PCI: the introduction of DES and DAPT.…”