Recent trends in Australian percutaneous coronary intervention practice: insights from the Melbourne Interventional Group registry

Abstract

To evaluate percutaneous coronary intervention (PCI) practice trends and 12-month outcomes in Australia in the era of drug-eluting stents (DES). Prospective study of consecutive patients undergoing 9204PCIs between 1April 2004and 31March 2008at seven Victorian public hospitals. Temporal trends in baseline characteristics and in-hospital and 12-month clinical outcomes including death, myocardial infarction (MI), target vessel revascularisation (TVR) and composite major adverse cardiac events (MACE), from year to year. Between 2004-2005and 2007-2008, the mean age of patients undergoing PCI was stable (65± 12years), and comorbidities such as hypertension, hyperlipidaemia, peripheral arterial disease and stroke increased (P<0.05). There were fewer elective and more urgent PCIs, especially for MI <24hours (17.6% in 2004-2005to 27.2% in 2007-2008, P<0.01). Overall stent use remained high (mean, 94.6%), but use of DES declined steadily (53.9% in 2004-2005to 32.0% in 2007-2008, P<0.01), despite increases in complex lesions. Planned clopidogrel therapy of ≥12months after insertion of DES increased from 54.7% in 2004-2005to 98.0% in 2007-2008(P<0.01). The overall procedural success rate was high (mean, 95.9%), and 12-month rates of mortality (3.8%), MI (4.8%), TVR (6.8%) and stent thrombosis (1.8%) remained low. Selective use of DES was an independent predictor of freedom from MACE at 12months (odds ratio, 0.68; 95% CI, 0.56-0.81). Use of DES declined steadily from 2004-2005to 2007-2008, despite increasing patient risk profile and lesion complexity. Procedural success remained high and 12-month adverse outcomes remained low, with increasing use of prolonged dual antiplatelet therapy.