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Previous Volume 341:1957-1965 December 23, 1999 Number 26 Next

	Full Text PDF Editorial by Jacobs, A. K. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The introduction and refinement of coronary-artery stenting dramatically changed the practice of percutaneous coronary revascularization in the mid-1990s. We analyzed one-year follow-up data for all percutaneous coronary interventions performed in a large, unselected population in Canada to determine whether the use of coronary stenting has been associated with improved outcomes.

Methods Prospectively collected data on all percutaneous coronary interventions performed on residents of British Columbia, Canada, between April 1994 and June 1997 were linked to province-wide health care data bases to provide the date of the following end points: subsequent target-vessel revascularization, myocardial infarction, and death. Base-line characteristics and procedural variables were identified and Kaplan–Meier survival curves were generated for 9594 procedures divided into seven groups, one for each sequential half-year period.

Results The overall burden of coexisting illnesses remained stable throughout the study period. A large increase in the rate of coronary stenting (from 14.2 percent in the period from April to June 1994 to 58.7 percent in the period from January to June 1997) was associated with a significant reduction in the rate of adverse cardiac events at one year (from 28.8 percent to 22.8 percent; adjusted relative risk, 0.79; 95 percent confidence interval, 0.69 to 0.90; P<0.001). This reduction in adverse events was exclusively due to a large reduction in subsequent target-vessel revascularization (from 24.4 percent to 17.0 percent; adjusted relative risk, 0.72; 95 percent confidence interval, 0.62 to 0.83; P<0.001) without significant changes in the overall rates of myocardial infarction (5.4 percent, P=0.28) or death (3.9 percent, P=0.65).

Conclusions The need for target-vessel revascularization during one year of follow-up after percutaneous coronary intervention decreased during the mid-1990s. The reduction was coincident with the introduction and subsequent widespread use of coronary stenting.

Source Information

From Vancouver General Hospital, Vancouver (J.M.R., D.R.R., I.M.P., C.E.B.); the British Columbian Cardiac Registries, Vancouver (J.J.S.); St. Paul's Hospital, Vancouver (R.G.C.); Royal Jubilee Hospital, Victoria (J.D.H.); and Royal Columbian Hospital, New Westminster (M.A.H., R.I.H.) — all in British Columbia, Canada.

Address reprint requests to Dr. Buller at Interventional Cardiology Research, 865 W. 10th Ave., Vancouver, BC V5Z 1L7, Canada, or at chbuller{at}interchange.ubc.ca.

Full Text of this Article

Related Letters:

Improved Clinical Outcome after Widespread Use of Coronary-Artery Stenting in Canada
Brophy J. M.
Extract | Full Text  
N Engl J Med 2000; 342:1448-1449, May 11, 2000. Correspondence

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