Abstract 14729: Has the COURAGE Trial Impacted Utilization of Elective Percutaneous Coronary Intervention (PCI) in Clinical Practice: Insights from BMC2 Registry
Introduction: In 2007, the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial demonstrated that a strategy of PCI is not superior to optimal medical therapy as an initial management strategy for patients with stable coronary artery disease (CAD). The effects of this new evidence on clinical practice are unknown.
Hypothesis: We hypothesize that clinical practice has been unresponsive to the conclusions posited in this trial.
Methods: We assessed for trends in PCI use for stable disease among 15 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) from January 2005 to September 2009. We also determined changes in pre-procedural medical therapy among stable patients during this time period. Stable CAD was defined as not meeting one of the following criteria: recent or acute MI, cardiogenic shock, those requiring IV nitrates, IV heparin, or GPIIbIIIa inhibitors.
Results: Of 111,218 PCI procedures performed during the study period, 47,606 (42%) met our definition of stable disease. The percentage of PCI procedures performed for stable disease remained unchanged although there was a decrease in the absolute numbers by quarter (2725 to 2215). The proportion of stable patients who underwent PCI after an abnormal stress test declined while there was an increased use of PCI for patients with stable angina pectoris (Fig). There was an increase in the use of pre-procedural aspirin (94.9 to 96.1%), lipid lowering therapy (72.2 to 79.6%), ace-inhibitor (41.4 to 45.4%) and beta-blocker (69.1 to 73.6%).
Conclusions: While there has been a decline in the absolute number of elective PCI procedures performed and an increase in optimal medical management prior to these procedures, there has been a concomitant increased use of PCI for patients with stable angina pectoris. Further research is warranted to understand the reasons for these divergent trends in treatment of patients with stable disease.
- © 2010 by American Heart Association, Inc.