(Circulation. 2000;102:2945.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Percutaneous Coronary Intervention in the Current Era Compared With 1985–1986
The National Heart, Lung, and Blood Institute Registries
From the Division of Cardiology (D.O.W.), Rhode Island Hospital, Brown University, Providence, RI; the Department of Epidemiology (R.H., W.Y., S.F.K., H.A.V., K.M.D.), University of Pittsburgh, Pittsburgh; Lankenau Hospital (P.C.), Philadelphia, Pa; Montreal Heart Institute (M.G.B.), Montreal, Quebec, Canada; Cardiovascular Medical Associates (M.A-B.), Houston, Tex; Providence/St. Vincent Hospitals (P.C.B.), Portland, Ore; University of Pittsburgh Medical Center (H.C.), Pittsburgh, Pa; Medical College of Virginia (M.C.), Richmond, Va; Arizona Heart Institute (G.D.), Phoenix, Az; University of Southern California Medical Center (D.F.), Los Angeles, Calif; Mayo Clinic Foundation (D.R.H.), Rochester, NY; Boston University Medical Center (A.J.), Boston, Mass; Emory University Hospital (S.B.K. III), Atlanta, Ga; Seton Medical Center (R.M.), Daly City, Calif; St. Lukes/Roosevelt Hospital (J.S.), New York, NY; and Institute for Clinical and Experimental Medicine (V.S.), Prague, Czech Republic.
Correspondence to Katherine M. Detre, MD, DrPH, University of Pittsburgh/GSPH, 130 DeSoto St, 127 Parran Hall, Pittsburgh, PA 15261. E-mail Detre{at}edc.gsph.pitt.edu
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Abstract |
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Background—Although refinements have occurred in coronary angioplasty over the past decade, little is known about whether these changes have affected outcomes.
Methods and Results—Baseline features and in-hospital and 1-year outcomes of 1559 consecutive patients in the 1997–1998 Dynamic Registry who were having first coronary intervention were compared with 2431 patients in the 1985–1986 National Heart, Lung, and Blood Institute Registry. Compared with patients in the 1985–1986 Registry, Dynamic Registry patients were older (mean age, 62 versus 58 years; P<0.001) and more often female (32.1% versus 25.5%; P<0.001). In the Dynamic Registry, procedures were more often performed for acute myocardial infarction (22.9% versus 9.9%; P<0.001) and treated lesions were more severe (84.5% versus 82.5% diameter reduction; P<0.001), thrombotic (22.1% versus 11.3%; P<0.001) or calcified (29.5% versus 10.8%; P<0.001). Stents were used in 70.5% of Dynamic Registry patients, whereas 1985–1986 patients received balloon angioplasty alone. Procedural success was higher in the Dynamic Registry (92.0% versus 81.8%; P<0.001) and the rate of in-hospital death, myocardial infarction, and emergency coronary bypass surgery combined was lower (4.9% versus 7.9%; P=0.001) than in the 1985–1986 Registry. The 1-year rate for CABG was lower in the Dynamic Registry (6.9% versus 12.6%; P<0.001).
Conclusions—Although Dynamic Registry patients had more unstable and complex coronary disease than those in the 1985–1986 Registry, their rate of procedural success was higher whereas rates of complications and subsequent CABG were lower. Results of percutaneous coronary intervention have improved substantially over the past decade.
Key Words: angioplasty • coronary disease • arteries • balloon • stents
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Introduction |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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In 1979, the National Heart, Lung, and Blood Institute (NHLBI) established a voluntary registry to characterize coronary angioplasty, at the time an emerging technique of percutaneous coronary revascularization.1 Patients were enrolled from 1977–1980 and subsequently from 1985–1986. These 2 registries provided the first comprehensive description of technical and clinical results, and in the mid-1980s identified that angioplasty had matured to the point that clinical trials were necessary to resolve the genuine dilemma as to potential comparability to CABG.
These trials, including Bypass Angioplasty Revascularization Investigation (BARI)2 and EAST,3 found that in most patients with multivessel coronary artery disease (CAD), balloon angioplasty did not compromise survival and proved to save costs slightly relative to CABG but many patients who received PTCA required repeat revascularization. Since that time, new devices have been developed as potential adjuncts or replacements for the balloon catheter.4 Although a few randomized clinical trials have helped to clarify the value of these new devices in limited patient subgroups,5 6 7 8 little is known of the extent of their use in overall clinical practice or of their effect on patient selection and outcomes.
The primary goal of the recently established Dynamic Registry is to characterize percutaneous coronary intervention in the new device era. The Registry provides the optimal design to assess and to compare with the 1985–1986 Registry the following: (1) contemporary patients and disease characteristics selected for percutaneous coronary intervention, (2) types of devices used in various settings, and (3) changes in interventional strategy as well as in-hospital and 1-year outcomes. The present report describes the findings from these comparisons.
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Methods |
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Design and Study Population
The Dynamic Registry includes 15 clinical centers (10 participants in the 1985–1986 Registry and 5 added to augment enrollment of minorities) and a Coordinating Center. Three sequential waves of 2000 patients, spaced 18 months apart, are to be enrolled. Each patient who is having percutaneous coronary catheter-based intervention performed by a Dynamic Registry investigator is registered. Informed consent is obtained to collect information after hospital discharge. The first wave of enrollment, which began July 1997 and was completed February 1998, recruited 2526 patients, of whom 2206 were consecutively enrolled. Because patients with prior angioplasty were excluded from the 1985–1986 Registry, for the sake of comparability, 647 Dynamic Registry patients with history of prior percutaneous coronary intervention are excluded from this report.
Data Collection
Registry research coordinators responsible for data
collection participated in a training session before patient
enrollment. Data collection included demographic information, medical
history, and risk factor profile. Coronary angiographic
information before and after intervention was obtained according to
definitions developed in previous registries and the Bypass Angioplasty
Revascularization
Investigation.1 9
Procedural strategy data included device use, procedural staging, and
success of each coronary lesion attempted. Successful lesion
dilatation was defined as an absolute 20% reduction in lesion severity
with final stenosis <50%. Angiographic success was classified
as either partial (some but not all attempted lesions successfully
treated) or total (all attempted lesions successfully treated).
Untoward events included death from any cause, myocardial infarction
(MI), or CABG. MI was defined as evidence of 
2 of the following: (1)
typical chest pain >20 minutes not relieved by
nitroglycerin, (2) serial ECG recordings
showing changes from baseline or serially in ST-T and/or Q-waves in 2
contiguous leads, or (3) serum enzyme elevation of CK-MB>5% of total
CK (total CK>2x normal; LDH subtype 1>LDH subtype 2). Congestive
heart failure was defined as presence of paroxysmal nocturnal dyspnea,
dyspnea on exertion, or radiographic pulmonary
congestion. Risk for CABG was classified as low, moderate, high, or
inoperable according to judgment of the interventionist. Procedures
were classified according to clinical circumstances: emergent when
required immediately because of clinical instability, urgent when
required within 24 hours to minimize cardiac risk, and elective when
deferrable >24 hours without cardiac risk. Procedural success was
defined as achievement of either partial or total angiographic success
without death, Q-wave MI, or emergency CABG.
Statistical Methods
Differences between proportions were assessed by
2 test or Fisher’s Exact Test when the
number of patients in a group was small. Continuous variables were
compared by Student’s t test.
One-year outcomes were reported with Kaplan-Meier estimates and log
rank statistics. Standard stepwise procedures were used with Cox
proportional hazards models to obtain adjusted relative risks comparing
the 2 registries. Consent to collect follow-up information after
initial procedure hospitalization was not obtained for 253 of the 1559
Dynamic patients, who were censored at the time of hospital discharge
in analyses of 1-year event
rates.
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Results |
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Although most of the consecutively enrolled patients in both registries were white men of middle age, prevalence of certain baseline characteristics differed between the 2 (Table 1
). Dynamic Registry patients were older; more often
female and nonwhite; more often had history of diabetes mellitus,
congestive heart failure, or hypertension; and more often were
considered to be at high risk for CABG. Dynamic Registry patients were
less likely to have history of prior MI or cigarette smoking. No
differences were noted in the extent of coronary
disease.
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Unstable angina was the most common procedural indication
for intervention in the Dynamic Registry
(Table 2). Compared with the 1985–1986 Registry, procedures
were more likely to be performed for acute MI (22.9% versus 9.9%;
P<0.001) and less frequently
for stable angina. Also, interventions were more often emergent (13.0%
versus 5.8%; P<0.001) for
Dynamic than for 1985–1986 Registry patients. Among the 357 Dynamic
patients with AMI as indication for intervention, 48.7% had emergent
intervention. Glycoprotein IIb/IIIa receptor
inhibitors, not available in the 1985–1986 Registry, were
administered to 25.3% of Dynamic Registry patients.
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Comparison of interventional strategy revealed some interesting trends. Most patients had procedures attempted on only 1 lesion, and fewer Dynamic Registry patients had multilesion procedures than in the 1985–1986 Registry. Multivessel attempt was 9% in the Dynamic compared with 20.7% in the 1985–1986 Registry (P<0.001). Balloon angioplasty, the only percutaneous intervention at the time of the 1985–1986 Registry, was used as the sole device in 24.7% of Dynamic Registry patients, concomitantly with stent placement in 63.7%, rotational atherectomy in 3.1%, and both stent and rotational atherectomy in 5.9% of patients. (Directional atherectomy, extraction atherectomy, and laser each were used in <1% of patients.)
Although the left anterior descending coronary
artery was the most common location for an attempted lesion in both
registries, lesions in other locations were more often attempted in the
Dynamic compared with the 1985–1986 Registry
(Table 3). Attempted lesion stenosis in the Dynamic
Registry was more severe, and lesions were more often total occlusions.
These differences were independent of sex of the patient or whether AMI
was the indication for intervention.
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Thrombus and calcification were reported far more frequently in the Dynamic Registry, yet angiographic success was achieved more often (93.7% versus 80.9%; P<0.001) and final lesion narrowing was less severe. Although abrupt artery closure was less common in the Dynamic Registry, side-branch occlusion and local coronary dissection were more common.
In-hospital mortality was not significantly different
between the registries
(Table 4), whereas MI and need for emergent CABG were
significantly lower in the Dynamic Registry. Both total angiographic
success and procedural success were achieved significantly more often
in the Dynamic Registry. In addition, mean length of hospital stay
decreased significantly, from 4.1 to 2.7 days. Overall incidence of
repeat revascularization during initial
hospitalization was 5.6% (4.2% repeat percutaneous
intervention and 1.5% CABG).
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Crude mortality during 1 year of follow-up was higher in the
Dynamic Registry compared with the 1985–1986 Registry (1-year rate,
5.4% versus 3.6%), whereas 1-year death or MI rate was similar
(Figure 1). After controlling for important baseline
differences between registries
(Table 5), death rates became comparable. Lower adjusted
mortality was not significant, although the 30% lower 1-year risk for
combined-endpoint death or MI achieved significance. Similarly, 1-year
CABG and repeat percutaneous procedure rates were
significantly lower in the Dynamic Registry both before and after
adjustment for baseline inequalities
(Figure 2). These findings were uniform regardless of number
of lesions or vessels attempted during the initial
procedure.
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Within the Dynamic Registry, differences were seen in unadjusted 1-year event rates within several clinically important subgroups. Women had higher 1-year mortality (7.6% versus 4.4%; P<0.05) and need for CABG (9.5% versus 5.6%; P<0.05) than men. Patients whose indication for intervention was AMI had higher 1-year mortality (9.2% versus 4.3%; P<0.001) than those with other indications, primarily due to higher in-hospital mortality (5.9% versus 0.7%; P<0.001). Use of GP IIb/IIIa receptor inhibitor was associated with increased 1-year MI rate (9.5% versus 4.0%; P<0.001), due in part to more in-hospital events (5.1% versus 2.0%; P<0.001). No differences were seen in 1-year death, MI, or revascularization by stent use during initial procedure.
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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In the contemporary Dynamic Registry, patients were older and more often had extensive cardiovascular morbidity compared with patients undergoing percutaneous coronary intervention a decade ago. Some of these observed differences may relate to the larger proportion of women in the Dynamic Registry, given that women presenting with CAD and symptoms requiring revascularization tend to be older and have more coronary risk factors than men do.10 11 12
Coronary intervention was more often performed in the setting of unstable coronary disease in the Dynamic Registry. In fact, AMI was reported as the primary indication for intervention more than twice as often as in 1985–1986. Because coronary angioplasty can be performed quickly and as an immediate adjunct to coronary angiography, it is particularly well suited for coronary syndromes in which rapid revascularization is essential.13 14 These findings may indicate that percutaneous intervention has become an established treatment for patients with acute coronary syndromes and may reflect a preference for a catheterization-based approach over medical or surgical alternatives.15 16 17 18
Substantial differences were found in revascularization strategy at both the lesion and patient levels. Calcification of attempted lesions was nearly 3-fold greater than in 1985–1986. The increase in lesions determined to be calcified may reflect more attention paid to this factor because of availability of rotational atherectomy and improved visibility of modern X-ray equipment and not necessarily a true increase in calcification.
Nearly twice as many attempted lesions showed evidence of thrombus, and attempted lesions had on average more severe stenosis. Lesion access was more difficult in the Dynamic Registry because more lesions were located in arteries other than the left anterior descending. All of these observations indicate that although operators now attempt fewer lesions, they attempt substantially more challenging lesions than in the past. The feasibility of treating more advanced coronary disease by percutaneous techniques has expanded the scope of patients eligible for this approach and is probably a reflection of improvements in angioplasty techniques and equipment.
Remarkably, although most Dynamic Registry patients had multivessel coronary disease and averaged nearly 3 significant lesions each, two-thirds had only 1 lesion attempted. Similarly, more than two thirds of patients with multivessel disease had a single vessel or graft targeted for revascularization. This shift to a more selective revascularization strategy was seen among patients treated outside of the AMI setting as well as among AMI patients, for whom initial intervention is usually performed to reestablish perfusion of the infarct-related artery rather than to achieve complete revascularization.15 A potential explanation for this observation is that some lesions may cause more ischemia than others19 and that operators place strategic emphasis in treating these lesions rather than others that may be of less functional significance. Operators may now also be more astute at identifying these "culprit" lesions. Certainly, the selective use of angioplasty in the Dynamic Registry was not based on a strategy of avoiding complex lesions, which were attempted more often than in the 1985–1986 Registry.
Despite treatment of older, less stable patients with more severe and complex lesions, procedural success rates were substantially higher in the Dynamic Registry than the 1985–1986 Registry. Coronary stenosis was relieved in a larger proportion of patients in the Dynamic registry, and magnitude of improvement was also much greater. Importantly, the increased lesion success was not achieved at the expense of additional risk.
Although angiographic dissection was observed more often, abrupt artery closure was substantially reduced in the Dynamic Registry. Although the reason for more dissection in contemporary practice is not readily apparent, potential explanations include more aggressive balloon angioplasty due to availability of stents or perhaps a change in threshold for declaring when dissection is present.
In-hospital mortality was not significantly different from the 1985–1986 Registry, and incidence of periprocedural MI and emergency CABG were significantly lower than a decade ago. With the increased rate of side-branch closure, probably as a result of stent use, a higher rate of periprocedural MI might have been expected. Because this effect was not observed, side-branch occlusion was probably limited to small arterial branches or transient.
Important differences in late outcome were also observed. Although 1-year crude mortality was higher in the new Registry, this difference was explained entirely by baseline differences between the 2 cohorts. Need for additional revascularization, either percutaneous or surgical, was 41% lower during 1-year follow-up in the Dynamic Registry. CABG reduction is explained mostly by lower procedural complications in the Dynamic Registry, whereas repeat procedure rates are gradually reduced over the entire follow-up period, which indicates important reductions in restenosis. Thus, current techniques have not only enhanced safety of percutaneous coronary revascularization, but also have augmented durability of the intervention.
Others have suggested that use of intracoronary stents may be responsible for improved results with contemporary percutaneous intervention.20 21 Our analysis found no difference in outcome between stented and nonstented patients. Accordingly, a significant percentage of patients may achieve a favorable clinical outcome without routine stent use. On the other hand, we cannot exclude a beneficial effect of stents. Because stent use is based on clinical judgment, stents were probably deployed in the Dynamic Registry patients most likely to benefit from stenting. Patients who did not receive stents may have been at low risk for complications or restenosis. Also, improved clinical outcome has been observed in trials of IIb/IIIa receptor antagonists.22 23 24 The present study does not support this effect and in fact demonstrated a higher MI rate among patients who received this therapy. However, proper interpretation of our finding requires acknowledgment that patients who received IIb/IIIa receptor blockade were more likely to have features associated with increased risk of complication. Outcomes for these patients might have been worse had this therapy not been administered. Finally, other factors, including more aggressive medical therapy and philosophies regarding indications for surgical revascularization, may have affected both in-hospital and 1-year outcomes.
Certain limitations must be acknowledged in interpretation of our findings. First, although the Dynamic Registry included a broad representation of clinical centers, most Registry investigators operated at large referral centers and were experienced interventional cardiologists. Whether the results achieved in the Registry apply to other types of institutions or given less experienced operators is unknown. Second, to permit meaningful comparison with the 1985–1986 Registry, Dynamic Registry patients who had had prior coronary intervention were not included in this analysis. These patients will be included in subsequent reports.
In summary, the Dynamic Registry has documented the substantial changes that have taken place in the field of percutaneous coronary intervention in the past decade. Patients now more often present with unstable coronary syndromes. Although revascularization strategy is somewhat more conservative than in 1985–1986, substantially more complex lesions are now being attempted. Rates of success are higher and acute complications lower compared with prior experience. Of particular importance is the documentation of the striking reduction in need for subsequent repeat surgical or percutaneous procedures. These results support use of percutaneous coronary interventions as effective means for achieving coronary revascularization.
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Acknowledgments |
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This work was supported in part by NHLBI grant HL33292-14.
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Footnotes |
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Additional coinvestigators are listed in the Appendix.
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Appendix 1 |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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Dynamic Registry Participants include the following: Rhode Island Hospital, Providence, RI: D.O. Williams, MD (Principal Investigator), and J. Raymond (Coordinator);St. Luke’s Medical Center, Milwaukee, Wis: G. Dorros, MD (Principal Investigator), and L. Mathiak (Coordinator); Lankenau Hospital, Wynnewood, Pa: P. Coady, MD (Principal Investigator) and E. Shappell (Coordinator); Seton Medical Center, Daly City, Calif: R. Myler, MD (Principal Investigator), R. Shaw, MD (Coinvestigator), and M. Murphy (Coordinator); University of Southern California, Los Angeles, Calif: D. Faxon, MD (Principal Investigator), and R.P. Singh, MD, and W. Hill (Coordinators); University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pa: H. Cohen, MD (Principal Investigator), and D. Rosenfelder and S. Iovino (Coordinators); Medical College of Virginia, Richmond, Va: M. Cowley, MD (Principal Investigator), and K. Hall (Coordinator); Providence/St. Vincent Medical Center, Portland, Ore: P. Block, MD (Principal Investigator), and E. Block (Coordinator); University of Maryland Hospital, Baltimore, Md: W. Laskey, MD (Principal Investigator), and D. Beach (Coordinator); Institute for Clinical and Experimental Medicine, Czech Republic: V. Stanek, MD (Principal Investigator), and M. Hrncarek, MD (Coordinator); St. Luke’s Roosevelt Hospital Center, New York, NY: J. Slater, MD (Principal Investigator), and D. Tormey (Coordinator); University of Pennsylvania Health System, Philadelphia, Pa: R. Wilenski, MD (Principal Investigator), and S. Hanlon (Coordinator); St. Mary’s Hospital, Rochester, Minn: D.R. Holmes, MD (Principal Investigator), and S. Brevig (Coordinator); Boston Medical Center, Boston, Mass: A. Jacobs, MD (Principal Investigator), and M. Mazur and S. Murphy (Coordinator); Emory University Hospital, Atlanta, Ga: S. King, MD (Principal Investigator), and C. Friedrich (Coordinator); Montreal Heart Institute, Montreal, Quebec, Canada: M.G. Bourassa, MD (Principal Investigator), Gilles Côté, MD (Coinvestigator), and S. Taillefer (Coordinator); and Cardiovascular Medicine Associates, Houston, Tex: M. Al-Bassam, MD (Principal Investigator), and D. Lance (Coordinator).
Personnel from the Coordinating Center, University of Pittsburgh, Pittsburgh, Pa, included the following: K. Detre, MD, DrPH (Director); S. Kelsey, PhD, R. Holubkov, PhD (Codirectors); M. Brooks, PhD, W. Yeh, H. Vlachos (Statisticians); V. Niedermeyer (Project Manager); S. Lawlor (Director, Data Management); E. Passano (Data Manager); J. Bondi and T. Ledneva (Data Entry); and N. Reck (Project Secretary).
NHLBI Project Office personnel included G. Sopko, MD, and P. Desvigne-Nickens, MD.
Received May 22, 2000; revision received July 20, 2000; accepted July 25, 2000.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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 S. Kanemitsu, K. Tanaka, J. Tanaka, H. Suzuki, and T. Kinoshita Initial clinical impact of drug eluting stents on coronary artery bypass graft surgery Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 632 - 635. [Abstract] [Full Text] [PDF]
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 W. K. Laskey, C. Jenkins, F. Selzer, O. C. Marroquin, R. L. Wilensky, R. Glaser, H. A. Cohen, D. R. Holmes Jr, and for the NHLBI Dynamic Registry Investigators Volume-to-Creatinine Clearance Ratio: A Pharmacokinetically Based Risk Factor for Prediction of Early Creatinine Increase After Percutaneous Coronary Intervention J. Am. Coll. Cardiol., August 14, 2007; 50(7): 584 - 590. [Abstract] [Full Text] [PDF]
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S. B. King III, T. Aversano, W. L. Ballard, R. H. Beekman III, M. J. Cowley, S. G. Ellis, D. P. Faxon, E. L. Hannan, J. W. Hirshfeld Jr, A. K. Jacobs, et al. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures) J. Am. Coll. Cardiol., July 3, 2007; 50(1): 82 - 108. [Full Text] [PDF]
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 M. Singh, C. S. Rihal, B. J. Gersh, R. J. Lennon, A. Prasad, P. Sorajja, R. E. Gullerud, and D. R. Holmes Jr Twenty-Five-Year Trends in In-Hospital and Long-Term Outcome After Percutaneous Coronary Intervention: A Single-Institution Experience Circulation, June 5, 2007; 115(22): 2835 - 2841. [Abstract] [Full Text] [PDF]
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L. Mauri, W.-h. Hsieh, J. M. Massaro, K. K.L. Ho, R. D'Agostino, and D. E. Cutlip Stent Thrombosis in Randomized Clinical Trials of Drug-Eluting Stents N. Engl. J. Med., March 8, 2007; 356(10): 1020 - 1029. [Abstract] [Full Text] [PDF]
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C. Berry, J.-C. Tardif, and M. G. Bourassa Coronary Heart Disease in Patients With Diabetes: Part II: Recent Advances in Coronary Revascularization J. Am. Coll. Cardiol., February 13, 2007; 49(6): 643 - 656. [Abstract] [Full Text] [PDF]
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A. Bakhai, G. W. Stone, E. Mahoney, T. A. Lavelle, C. Shi, R. H. Berezin, B. J. Lahue, M. A. Clark, M. J. Lacey, M. E. Russell, et al. Cost Effectiveness of Paclitaxel-Eluting Stents for Patients Undergoing Percutaneous Coronary Revascularization: Results From the TAXUS-IV Trial J. Am. Coll. Cardiol., July 18, 2006; 48(2): 253 - 261. [Abstract] [Full Text] [PDF]
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 C. Spaulding, M.-C. Morice, B. Lancelin, S. El Haddad, E. Lepage, S. Bataille, J.-P. Tresca, X. Mouranche, S. Fosse, M. Monchi, et al. Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry Eur. Heart J., May 1, 2006; 27(9): 1054 - 1060. [Abstract] [Full Text] [PDF]
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 A K Mitra and D K Agrawal In stent restenosis: bane of the stent era. J. Clin. Pathol., March 1, 2006; 59(3): 232 - 239. [Abstract] [Full Text] [PDF]
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D. S. Baim, R. Mehran, D. J. Kereiakes, T. P. Gross, M. Simons, D. Malenka, and A. V. Kaplan Postmarket Surveillance for Drug-Eluting Coronary Stents: A Comprehensive Approach Circulation, February 14, 2006; 113(6): 891 - 897. [Full Text] [PDF]
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M. Moscucci, E. K. Rogers, C. Montoye, D. E. Smith, D. Share, M. O'Donnell, A. Maxwell-Eward, W. L. Meengs, A. C. De Franco, K. Patel, et al. Association of a Continuous Quality Improvement Initiative With Practice and Outcome Variations of Contemporary Percutaneous Coronary Interventions Circulation, February 14, 2006; 113(6): 814 - 822. [Abstract] [Full Text] [PDF]
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 J. Sprung, M. J. Ritter, C. S. Rihal, M. E. Warner, G. A. Wilson, B. A. Williams, S. R. Stevens, D. R. Schroeder, D. L. Bourke, and D. O. Warner Outcomes of Cardiopulmonary Resuscitation and Predictors of Survival in Patients Undergoing Coronary Angiography Including Percutaneous Coronary Interventions Anesth. Analg., January 1, 2006; 102(1): 217 - 224. [Abstract] [Full Text] [PDF]
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E. H. Yang, R. J. Gumina, R. J. Lennon, D. R. Holmes Jr, C. S. Rihal, and M. Singh Emergency Coronary Artery Bypass Surgery for Percutaneous Coronary Interventions: Changes in the Incidence, Clinical Characteristics, and Indications From 1979 to 2003 J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2004 - 2009. [Abstract] [Full Text] [PDF]
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G. W. Stone, N. J. Reifart, I. Moussa, A. Hoye, D. A. Cox, A. Colombo, D. S. Baim, P. S. Teirstein, B. H. Strauss, M. Selmon, et al. Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part II Circulation, October 18, 2005; 112(16): 2530 - 2537. [Full Text] [PDF]
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G. W. Stone, D. E. Kandzari, R. Mehran, A. Colombo, R. S. Schwartz, S. Bailey, I. Moussa, P. S. Teirstein, G. Dangas, D. S. Baim, et al. Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part I Circulation, October 11, 2005; 112(15): 2364 - 2372. [Full Text] [PDF]
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 J. A. Brinker, C. J. Davidson, and W. Laskey Preventing in-hospital cardiac and renal complications in high-risk PCI patients Eur. Heart J. Suppl., August 1, 2005; 7(suppl_G): G13 - G24. [Abstract] [Full Text] [PDF]
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 C. K. Prasad, K. R. Resmi, L. K. Krishnan, and R. Vaishnav Survival of Endothelial Cells in vitro on Paclitaxel-loaded Coronary Stents J Biomater Appl, April 1, 2005; 19(4): 271 - 286. [Abstract] [PDF]
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 H. Nishi, S. Miyamoto, S. Takanashi, H. Minamimura, T. Ishikawa, Y. Kato, and Y. Shimizu Optimal Method of Coronary Endarterectomy for Diffusely Diseased Coronary Arteries Ann. Thorac. Surg., March 1, 2005; 79(3): 846 - 852. [Abstract] [Full Text] [PDF]
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 G Montalescot, B Chevalier, M C Dalby, P G Steg, M-C Morice, A Cribier, P Meyer, and F Alor Description of modern practices of percutaneous coronary intervention and identification of risk factors for adverse outcome in the French nationwide OPEN registry Heart, January 1, 2005; 91(1): 89 - 90. [Full Text] [PDF]
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D. J. Cohen, A. Bakhai, C. Shi, L. Githiora, T. Lavelle, R. H. Berezin, M. B. Leon, J. W. Moses, J. P. Carrozza Jr, J. P. Zidar, et al. Cost-Effectiveness of Sirolimus-Eluting Stents for Treatment of Complex Coronary Stenoses: Results From the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) Trial Circulation, August 3, 2004; 110(5): 508 - 514. [Abstract] [Full Text] [PDF]
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M. A. Clark, A. Bakhai, M. J. Lacey, E. M. Pelletier, and D. J. Cohen Clinical and Economic Outcomes of Percutaneous Coronary Interventions in the Elderly: An Analysis of Medicare Claims Data Circulation, July 20, 2004; 110(3): 259 - 264. [Abstract] [Full Text] [PDF]
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R. L. Benza, G. J. Zoghbi, J. Tallaj, R. Brown, J. K. Kirklin, M. Hubbard, B. Rayburn, B. Foley, D. C. McGiffin, L. J. Pinderski, et al. Palliation of allograft vasculopathy with transluminal angioplasty: A decade of experience J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1973 - 1981. [Abstract] [Full Text] [PDF]
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 H. L. Lazar Coronary sinus retroperfusion: Can forward progress still be achieved by using a backward technique? J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1549 - 1552. [Full Text] [PDF]
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 P. H Chong and J. W. Cheng Early Experiences and Clinical Implications of Drug-Eluting Stents: Part 1 Ann. Pharmacother., April 1, 2004; 38(4): 661 - 669. [Abstract] [Full Text] [PDF]
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D. Greenberg, A. Bakhai, and D. J. Cohen Can we afford to eliminate restenosis?: Can we afford not to? J. Am. Coll. Cardiol., February 18, 2004; 43(4): 513 - 518. [Abstract] [Full Text] [PDF]
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K. N. Giedd and S. R. Bergmann Myocardial perfusion imaging following percutaneous coronary intervention: the importance of restenosis, disease progression, and directed reintervention J. Am. Coll. Cardiol., February 4, 2004; 43(3): 328 - 336. [Abstract] [Full Text] [PDF]
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M. Lotfi, K. Mackie, V. Dzavik, and P. H. Seidelin Impact of delays to cardiac surgery after failed angioplasty and stenting J. Am. Coll. Cardiol., February 4, 2004; 43(3): 337 - 342. [Abstract] [Full Text] [PDF]
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G. J. Dehmer and D. S. Gantt Coronary intervention at hospitals without on-site cardiac surgery: are we pushing the envelope too far? J. Am. Coll. Cardiol., February 4, 2004; 43(3): 343 - 345. [Full Text] [PDF]
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 D. R. Holmes Jr Risk Stratification and Interventional Cardiology: Robert L. Frye Lecture Mayo Clin. Proc., December 1, 2003; 78(12): 1507 - 1518. [Abstract] [PDF]
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M. Singh, C. S. Rihal, F. Selzer, K. E. Kip, K. Detre, and D. R. Holmes Jr Validation of Mayo clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1722 - 1728. [Abstract] [Full Text] [PDF]
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M. P. Kelley, B. D. Klugherz, S. M. Hashemi, N. F. Meneveau, J. M. Johnston, W. H. Matthai Jr, V. S. Banka, H. C. Herrmann, J. W. Hirshfeld Jr, S. E. Kimmel, et al. One-year clinical outcomes of protected and unprotected left main coronary artery stenting Eur. Heart J., September 1, 2003; 24(17): 1554 - 1559. [Abstract] [Full Text] [PDF]
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 G. N. Levine, M. J. Kern, P. B. Berger, D. L. Brown, L. W. Klein, D. J. Kereiakes, T. A. Sanborn, A. K. Jacobs, and for the American Heart Association Diagnostic and Management of Patients Undergoing Percutaneous Coronary Revascularization Ann Intern Med, July 15, 2003; 139(2): 123 - 136. [Abstract] [Full Text] [PDF]
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S. R. Bergmann and K. N. Giedd Silent ischemia: unsafe at any time J. Am. Coll. Cardiol., July 2, 2003; 42(1): 41 - 44. [Full Text] [PDF]
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J. M. Brophy, P. Belisle, and L. Joseph Evidence for Use of Coronary Stents: A Hierarchical Bayesian Meta-Analysis Ann Intern Med, May 20, 2003; 138(10): 777 - 786. [Abstract] [Full Text] [PDF]
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D. R. Holmes, F. Selzer, J. M. Johnston, S. F. Kelsey, R. Holubkov, H. A. Cohen, D. O. Williams, and K. M. Detre Modeling and Risk Prediction in the Current Era of Interventional Cardiology: A Report From the National Heart, Lung, and Blood Institute Dynamic Registry Circulation, April 15, 2003; 107(14): 1871 - 1876. [Abstract] [Full Text] [PDF]
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A. C. Ferreira, A. A. Peter, T. A. Salerno, H. Bolooki, and E. de Marchena Clinical impact of drug-eluting stents in changing referral practices for coronary surgical revascularization in a tertiary care center Ann. Thorac. Surg., February 1, 2003; 75(2): 485 - 489. [Abstract] [Full Text] [PDF]
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D. J. Malenka, D. E. Wennberg, H. A. Quinton, D. J. O'Rourke, P. D. McGrath, S. J. Shubrooks Jr, G. T. O'Connor, T. J. Ryan Jr, J. F. Robb, M. A. Kellett Jr, et al. Gender-related changes in the practice and outcomes of percutaneous coronary interventions in northern New England from 1994 to 1999 J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2092 - 2101. [Abstract] [Full Text] [PDF]
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V.S. Srinivas, M. M. Brooks, K. M. Detre, S. B. King III, A. K. Jacobs, J. Johnston, and D. O. Williams Contemporary Percutaneous Coronary Intervention Versus Balloon Angioplasty for Multivessel Coronary Artery Disease: A Comparison of the National Heart, Lung and Blood Institute Dynamic Registry and the Bypass Angioplasty Revascularization Investigation (BARI) Study Circulation, September 24, 2002; 106(13): 1627 - 1633. [Abstract] [Full Text] [PDF]
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L. S. Fernandes, J. E. Tcheng, J. C. O'Shea, B. Weiner, T. J. Lorenz, C. Pacchiana, L. G. Berdan, K. J. Maresh, D. Joseph, M. Madan, et al. Is glycoprotein IIb/IIIa antagonism as effective in women as in men following percutaneous coronary intervention?: Lessons from the ESPRIT study J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1085 - 1091. [Abstract] [Full Text] [PDF]
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M. Ruscazio, R. Montisci, P. Colonna, C. Caiati, L. Chen, G. Lai, M. Cadeddu, R. Pirisi, and S. Iliceto Detection of coronary restenosis aftercoronary angioplasty by contrast-enhanced transthoracic echocardiographic Doppler assessment of coronary flow velocity reserve J. Am. Coll. Cardiol., September 4, 2002; 40(5): 896 - 903. [Abstract] [Full Text] [PDF]
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D. J. Cohen, R. S. Cosgrove, R. H. Berezin, P. S. Teirstein, M. B. Leon, R. E. Kuntz, and on behalf of the Gamma-1 Investigators Cost-Effectiveness of Gamma Radiation for Treatment of In-Stent Restenosis: Results From the Gamma-1 Trial Circulation, August 6, 2002; 106(6): 691 - 697. [Abstract] [Full Text] [PDF]
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M. Singh, H. H. Ting, P. B. Berger, K. N. Garratt, D. R. Holmes Jr, and B. J. Gersh Rationale for on-site cardiac surgery for primary angioplasty: a time for reappraisal J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1881 - 1889. [Abstract] [Full Text] [PDF]
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 J. Huang and C. D. Kontos Inhibition of Vascular Smooth Muscle Cell Proliferation, Migration, and Survival by the Tumor Suppressor Protein PTEN Arterioscler Thromb Vasc Biol, May 1, 2002; 22(5): 745 - 751. [Abstract] [Full Text] [PDF]
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H. V. Anderson, R. E. Shaw, R. G. Brindis, K. Hewitt, R. J. Krone, P. C. Block, C. R. McKay, W. S. Weintraub, and ACC-NCDR A contemporary overview of percutaneous coronary interventions: The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1096 - 1103. [Abstract] [Full Text] [PDF]
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R. E. Shaw, H. V. Anderson, R. G. Brindis, R. J. Krone, L. W. Klein, C. R. McKay, P. C. Block, L. J. Shaw, K. Hewitt, W. S. Weintraub, et al. Development of a risk adjustment mortality model using the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) experience: 1998-2000 J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1104 - 1112. [Abstract] [Full Text] [PDF]
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A. B. Buchwald, A. H. Wagner, C. Webel, and M. Hecker Decoy oligodeoxynucleotide againstactivator protein-1 reducesneointimal proliferation after coronaryangioplasty in hypercholesterolemic minipigs J. Am. Coll. Cardiol., February 20, 2002; 39(4): 732 - 738. [Abstract] [Full Text] [PDF]
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S. Rinfret, C. L. Grines, R. S. Cosgrove, K. K. L. Ho, D. A. Cox, B. R. Brodie, M.-C. Morice, G. W. Stone, D. J. Cohen, and the Stent-PAMI Investigators Quality of life after balloon angioplasty or stenting for acute myocardial infarction: One-year results from the Stent-PAMI trial J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1614 - 1621. [Abstract] [Full Text] [PDF]
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T. Suzuki, G. Kopia, S.-i. Hayashi, L. R. Bailey, G. Llanos, R. Wilensky, B. D. Klugherz, G. Papandreou, P. Narayan, M. B. Leon, et al. Stent-Based Delivery of Sirolimus Reduces Neointimal Formation in a Porcine Coronary Model Circulation, September 4, 2001; 104(10): 1188 - 1193. [Abstract] [Full Text] [PDF]
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D. O. Williams Carotid Filters : New Additions to the Interventionist's Toolbox Circulation, July 3, 2001; 104(1): 2 - 3. [Full Text] [PDF]
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T. M. Bashore, E. R. Bates, P. B. Berger, D. A. Clark, J. T. Cusma, G. J. Dehmer, M. J. Kern, W. K. Laskey, M. P. O'Laughlin, S. Oesterle, et al. American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on Cardiac Catheterization Laboratory Standards: A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents endorsed by the American Heart Association and the Diagnostic and Interventional Catheterization Committee of the Council on Clinical Cardiology of the AHA J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2170 - 2214. [Full Text] [PDF]
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S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
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R. Seabra-Gomes Every piece is important to build a puzzle. What can we learn from early experiences with balloon PTCA? Eur. Heart J., June 1, 2001; 22(11): 891 - 893. [PDF]
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 Improved Outcomes with Percutaneous Coronary Interventions Journal Watch (General), January 9, 2001; 2001(109): 5 - 5. [Full Text]
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H. V. Anderson and B. A. Carabello Provisional Versus Routine Stenting : Routine Stenting Is Here To Stay Circulation, December 12, 2000; 102(24): 2910 - 2914. [Full Text] [PDF]
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