The patient population undergoing percutaneous coronary intervention (PCI) has substantially changed over the last 20 years, according to a new Swedish registry analysis published March 18 in the Journal of the American College of Cardiology.

Full Analysis Journal Scan  2011 ACCF/AHA/SCAI Guidelines for PCI

The study, based on 144,039 patients enrolled in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) between January 1990 and December 2010, found that patients undergoing PCI in Sweden have grown older and sicker, and PCI is more often indicated for acute conditions. Specifically, the mean age in the registry increased from 60.1 years in the 1990-1995 cohort to 67.1 years in the 2009-2010 cohort, and the proportion of patients ≥75 years increased from 5.8 percent to 28.4 percent.

The indication for PCI also changed over time. In the 1990-1995 cohort, the majority of patients (66.4 percent) underwent PCI for stable coronary artery disease, whereas the majority of patients in the 2009-2010 cohort presented with unstable coronary artery disease (47.7 percent) and STEMI (32.5 percent). There was also an increase in the prevalence of diabetes and hypertension, which the investigators attributed to the aging population.

Nevertheless, the study authors did note a decrease in mortality. While the crude one-year mortality rate increased from 2.2 percent in 1990-1995 to 5.9 percent in 2009-2010 (p<0.001), after adjustment for age and indication, there was a modest decrease in mortality risk over time that was mainly associated with a decrease in mortality among patients with STEMI.

Moving forward, the authors suggest that future trials should be designed to take into account the changing patient population.

Keywords: Prevalence, Registries, Coronary Artery Disease, Sweden, Coronary Angiography, Coronary Disease, Angioplasty, Balloon, Coronary, Hypertension, Diabetes Mellitus, United States, Percutaneous Coronary Intervention

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