Recent Changes in Practice of Elective Percutaneous Coronary Intervention for Stable Angina

Study Questions:

What is the impact of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial on use of percutaneous coronary intervention (PCI) for stable angina?

Methods:

The authors assessed for trends in number of patients undergoing PCI for stable angina among the hospitals participating in the Northern New England Cardiovascular Disease PCI Registry between January 2006 and June 2009. A “COURAGE-like” patient cohort was defined as patients who were undergoing an elective procedure for an indication of stable angina on the day of admission.

Results:

Total PCI volume per quarter decreased from 2,064 patients in quarter 1, 2006 (before the COURAGE trial) to 1,708 patients in quarter 3, 2007 (after the COURAGE trial) (p < 0.01). This was almost entirely driven by a change in PCI for stable angina, and no decrease in PCI for any other indication was seen. The proportion of patients undergoing PCI for stable angina decreased from 20% pre-COURAGE trial to 16% post-COURAGE trial.

Conclusions:

The authors concluded that the publication of the COURAGE trial was associated with an immediate decline in use of PCI for stable angina.

Perspective:

This study demonstrates the rapid decline in PCI for stable angina that followed the publication of the COURAGE trial. These results reflect the practice at nine hospitals involved in an active quality improvement initiative, and it would be interesting to see if a similar change was seen across all or most hospitals in the United States.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Quality Improvement, Angina, Stable, Cardiology, New England, United States, Percutaneous Coronary Intervention, Drug Evaluation


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