Abstract 3235: Twenty Years of Percutaneous Coronary Intervention - The Evolution and the Impact. A Report from the National Heart, Lung and Blood Institute-Sponsored PTCA (1985–86) and Dynamic (1997–2004) Registries
Background: Technological advancements in percutaneous coronary intervention (PCI), since the pre-stent era, have widened the scope of its use. The NHLBI-sponsored 1985– 86 PTCA (pre-stent) registry and 4 Dynamic Registry (DR) waves: 1997–98 (bare metal stents), 1999 (uniform use), 2001– 02 (brachytherapy) and 2003– 04 (drug-eluting stents) - document this evolution and its impact.
Methods: Trend in characteristics of consecutive cases of de novo PCI and risk of 1-year outcomes were analyzed.
Results: Patient and procedural profile, in the latter waves, have expanded to include more elderly patients with a concomitant rise in acuity (table⇓); revascularization strategy was more often the ‘culprit lesion’ approach. Evolution of stents was reflected in their mounting use from 70.3% in wave 1 (only bare metal) to 95.2% in wave 4 (72.0% drug-eluting). Adjunct therapy including IIb/IIIa inhibitors (25.2% in wave 1 to 36.5% in wave 4) and antiplatelet agents (51.6% in wave 1 to 85.2% in wave 4) were also utilized more recently. Procedural success and reduction in abrupt closures were achieved more often in the stent era, despite the higher severity of lesions; however, the advent of stents initially saw higher local dissection (PTCA registry: 2.6%, Wave 1: 11.6%) and side branch occlusion (PTCA registry: 0.4%, Wave 1: 3.2%) rates that tapered in the most recent cohort. Although repeat revascularization rates reduced over time (PTCA registry: 28.5%, Wave 4: 10.5%), the risk of ‘early’ repeat PCI was 1–2 fold higher in DR when compared to the PTCA registry. Post-procedural rates of myocardial infarction and bypass surgery markedly decreased with no significant change in mortality after adjusting for baseline differences.
Conclusion: PCI, over 2 decades, has progressed from de novo lesions to grounds once considered dominion of bypass surgery. Escalating use in conjunction with appreciable success rates, are noteworthy given the complexity of patients and lesions being treated.