Abstract 3510: The Use of Percutaneous Coronary Intervention in Patients with Class I Indications for Coronary Artery Bypass Graft Surgery: Data from the National Cardiovascular Data Registry
BACKGROUND While both percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) can be used to treat patients with severe, multivessel coronary artery disease, the durability of CABG has often favored that strategy of revascularization. Randomized clinical trials are underway to compare multivessel PCI with drug eluting stents (DES) and CABG. Whether the introduction of DES has altered national practice patterns in advance of this evidence is unknown.
METHODS We identified all patients who had ACC/AHA Class I indications for non-emergency CABG at centers reporting both diagnostic catheterization and PCI data to the National Cardiovascular Data Cath/PCI Registry from 1/1/2001 to 12/31/2005. Temporal trends in PCI use were analyzed in three periods: pre-DES era, (prior to 4/1/2003, date of Cypher stent approval), the DES-diffusion era, (4/1/2003 – 12/31/2004, time to achieve >75% DES use), and the DES era (1/1/2005 – 12/31/2005). We used hierarchical, multivariable logistic regression to identify predictors of PCI use.
RESULTS Since the introduction of DES, the proportion of patients with Class I indications for CABG who received PCI increased significantly (Table⇓). The unadjusted rate of increase in PCI use among patients with Class I indications for CABG during the DES era exceeded that of the pre-DES (P =0.019) or DES-diffusion era (P=0.029). In multivariable, hierarchical logistical regression models, there was a strong, independent association between later time periods and the preferential use of PCI.
CONCLUSION The introduction and diffusion of DES into clinical practice has coincided with a significant increase in the use of PCI to treat patients who have ACC Class I indications for CABG. This practice shift precedes evidence from randomized clinical trials. Further studies of this patient population are essential to determine the overall impact of this shift on long-term patient outcomes.