Drug-Eluting Stents and the Use of Percutaneous Coronary Intervention Among Patients With Class I Indications for Coronary Artery Bypass Surgery Undergoing Index RevascularizationAnalysis From the NCDR (National Cardiovascular Data Registry)
Andrew D. Frutkin, MD*,
Jason B. Lindsey, MD*,
Sameer K. Mehta, MD*,
John A. House, MS*,
John A. Spertus, MD, MPH*,
David J. Cohen, MD, MSc*,
John S. Rumsfeld, MD, PhD ,
Steven P. Marso, MD*,* on behalf of the NCDR (National Cardiovascular Data Registry)
* Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
Denver Veteran's Affairs Medical Center, University of Colorado Health Sciences Center, Denver, Colorado
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Figure 1 DES Use in PCIs
The proportion of patients undergoing percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) by quarter from 2001 to 2006 during the pre-DES, DES diffusion, and DES era in the entire National Cardiovascular Data Registry population (A) and limited to patients with class I indications for coronary artery bypass grafting (CABG) (B). DES use increased to a maximum of 88% in all PCIs during the second quarter of 2005. Definitions of each time interval as in Table 1.
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Figure 2 PCI Attempts in Patients With Class I Indications for CABG
The proportion of patients with class I CABG indications undergoing attempted PCI by quarter from 2001 to 2006 during the pre-DES, DES diffusion, and DES era. *p < 0.001 versus pre-DES era. The quarterly slope of increase was 2-fold greater in the DES than the DES diffusion and pre-DES eras. *p = 0.03 versus pre-DES era. Abbreviations as in Figure 1. Definitions of each time interval as in Table 1.
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Figure 3 Hierarchical Multivariable Logistic Regression Model
Predictors of PCI in patients with class I coronary artery bypass grafting indications. Solid circles represent odds ratios; lines are 95% confidence intervals. ACS = acute coronary syndromes; CVD = cardiovascular disease; Dx = diseased; LM = left main; MI = myocardial infarction; PVD = peripheral vascular disease; other abbreviations as in Table 1.
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Figure 4 Quarterly PCI Attempts by Decile of DES Utilization
A hierarchical multivariable logistic regression model with quarterly DES utilization rate as the main effect of interest was developed to determine the adjusted rate of PCI attempted during the DES era at each hospital site (p = 0.036). The Y-axis is the PCI attempt rate in patients with a class I indication for coronary artery bypass grafting. The X-axis is the mean quarterly DES utilization rate by center. Abbreviations as in Figure 1.
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