Comparative Outcomes for Patients Who Do and Do Not Undergo Percutaneous Coronary Intervention for Stable Coronary Artery Disease in New York
Background—Little is known about what treatments patients receive after being diagnosed with stable coronary artery disease (CAD), or what the comparative outcomes are for routine medical treatment (RMT) vs. percutaneous coronary intervention (PCI) with RMT for patients in a setting apart from randomized controlled trials.
Methods and Results—Patients with stable CAD undergoing cardiac catheterization in New York State between 2003 and 2008 were followed to determine the treatment they received. Patients receiving RMT and patients receiving PCI with RMT, were propensity matched using 20 factors that could have a bearing on outcomes. The resulting cohort of 933 matched pairs was used to compare mortality/myocardial infarction (MI), mortality, MI, and subsequent revascularization rates. A total of 89% of all patients underwent PCI with RMT. PCI/RMT patients had significantly lower adverse outcome rates at 4 years for mortality/MI (16.5% vs. 21.2%, P=0.003), mortality (10.2% vs. 14.5%, P= 0.02), MI (8.0% vs. 11.3%, P =0.007), and subsequent revascularization (24.1% vs. 29.1%, P= 0.005). Adjusted RMT vs. (PCI with RMT) hazard ratios were 1.49 (95% CI (1.16, 1.93) for mortality/MI and, 1.46 (1.08, 1.97) for mortality. There were no differences for patients under age 65 or for patients with single vessel disease.
Conclusions—Most patients with stable CAD in New York undergoing catheterization between 2003 and 2008 received PCI. Patients who received PCI experienced lower mortality, mortality/MI, and revascularization rates. The reasons for this need to be better understood, including the possible role of low medication adherence rates that have been found in other studies.
- comparative effectiveness
- coronary artery disease
- medical therapy
- percutaneous coronary intervention
- stable coronary artery disease
- Received October 7, 2011.
- Accepted February 17, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited