Abstract 4296: Recent Changes in the Practice of Elective PCI for Stable Angina
BACKGROUND: On March 27, 2007 COURAGE was published, reporting comparable outcomes at 4.6 years for stable angina patients undergoing PCI versus optimal medical management. The influence of these results on clinical practice is unknown.
METHODS: We analyzed 10,294 consecutive patients from the Northern New England Cardiovascular Disease PCI Registry who underwent PCI at 10 institutions between January 2007 and June 2008. Stable Angina patients were defined as those undergoing an elective PCI as an outpatient or within 24 hours of admission, who were asymptomatic or had chronic stable angina. We compared change over time in the number of Stable Angina patients undergoing PCI by 3-month time periods, using Quarter 1 2007 as the referent group, as well as change over time for all “Other Indications”.
RESULTS: During the study period 1,511 (14.7%) underwent PCI for Stable Angina while 8,783 (85.3%) underwent PCI for Other Indications. Compared to Quarter 1, 2007 when COURAGE was published, there was an immediate 13% decrease in the percent Stable Angina patients in Quarter 2 2007 (Figure⇓). The decreasing volume of PCI for Stable Angina reached a nadir of 33% in Quarter 3 2007, rebounding to a 17% decrease in Quarter 2 2008 (p<0.001). This trend was seen across all institutions. Patient and procedural characteristics did not differ by quarter. The volume of PCI for Other Indications dipped transiently by 8% (p=0.636) in Quarter 3 2007.
CONCLUSIONS: Elective PCI for Stable Angina comprised 14.7% of recent PCI volumes in Northern New England. Publication of the COURAGE trial was temporally associated with a significant and sustained decrease in the utilization of PCI to treat Stable Angina.