Landes U, et al. - This study analyzed temporal trends in the practice and outcome of percutaneous coronary intervention (PCI) during the drug eluting stent (DES) era. Findings revealed that shift to second generation DES and to enhanced PCI techniques may partly explain the reported progress in the evolution of PCI in the last decade, reflected by the better outcome afforded by PCI in more elderly, sicker patient population, with more complex coronary disease interventions.

Methods

• An analysis was performed of 18,641 consecutive PCI's performed between January 2004 and December 2016, distinguished by procedural date (Q₁: 2004–2006, n = 4,865; Q₂: 2007–2009, n = 4,977; Q₃: 2010–2012, n = 4,230; Q₄: 2013–2016, n = 4,569).

Results

• Data reported that at presentation, mean patients age was 65 (±11) years and 22.8% were females.
• Findings showed over time rise in the relative number of octogenarians (Q₁: 10.7% vs Q4: 15.5%, P < 0.001) and increase in the burden of most comorbidities (e.g., left ventricular dysfunction ≥ moderate and chronic kidney disease, P < 0.001 for both).
• Researchers noted that the radial approach was increasingly adopted (Q1: 2% to Q4: 63.5%, P < 0.001) though a 2-fold increase in the rate of complex interventions was noted, in addition to a 3-fold increase in the rate of unprotected left-main angioplasty (P < 0.001 for both).
• They also observed that DES implantation increased from 43% to 83% at the expense of bare metal stent (BMS) application, and accompanied by drug coated balloon sprout to 1.8%, P < 0.001.
• Additionally, a time-based enhanced outcome was demonstrated in Kaplan–Meier survival curves, with a decreased rate of death, MI, target vessel revascularization and CABG over the years.