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Kumsa NB, Kelly TL, Roughead EE, Tavella R, Gillam MH. Temporal trends in percutaneous coronary intervention in Australia: A retrospective analysis from 2000-2021. Hellenic J Cardiol 2023:S1109-9666(23)00193-8. [PMID: 37863429 DOI: 10.1016/j.hjc.2023.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
OBJECTIVE The aim of this study was to describe the trend in percutaneous coronary intervention (PCI) with insertion of a stent in Australia from 2000/01 to 2020/21 and investigate trends in same-day versus non-same-day discharge following PCI. A secondary aim was to compare the rate of coronary artery bypass grafting (CABG) with PCI procedures, while a third aim was to compare marked PCI trend changes with the PCI guidelines during the study period. BACKGROUND PCI with stent deployment is the most common form of interventional treatment for coronary artery disease, and its use has been expanding since 2000. However, there is a lack of descriptive studies of the national trend in Australia. METHODS All procedures for PCI and CABG were extracted across 21 years (2000/01 to 2020/21) from the Australian Institute of Health and Welfare data. Age-standardized rates were calculated using the Australian standard population as of June 2001. The ratio of PCI to CABG procedures was also calculated. Trends for PCI were stratified by age, gender, and same-day or overnight discharge episodes. Linear regression analysis was done to compare the age-standardized rates across different age categories. Segmented regression analysis was performed to ascertain the change in the age-standardized rates of PCI during the study period. Whether the changepoints in the trend were matched with guideline updates was also assessed. RESULTS There were 751 728 PCI procedures in persons aged 30 years and above between 2000/01 and 2020/21. The age-standardized rate for the study period showed that persons aged 60-74 years had a higher rate of procedures (102.7) compared to persons aged 30-59 years (81.3) and 75 years and older (61.8) (P < 0.001). There were two statistically significant changepoints in the overall trend; 2005/06 and 2013/14, matched with the change in PCI guidelines. Despite the lower number of procedures for same-day discharge episodes, there has been an increasing trend since 2014/15. More than two-thirds of all stenting procedures were the insertion of a single stent. PCI to CABG procedure ratio increased from 0.6 in 2000/01 to 1.8 in 2020/21. CONCLUSIONS There was a varying trend in the age-standardized rate of PCI with a peak in 2005/06. The trend appears to be stabilizing in the later part of the study period, but the rate for same-day discharge episodes showed an increasing trend after 2014/15. There is consistency with changepoints in the trend and updated PCI guideline recommendations. The ratio of PCI with insertion of a stent to CABG procedure increased substantially across the study period.
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Affiliation(s)
- Netsanet B Kumsa
- Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
| | - Thu-Lan Kelly
- Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
| | - Elizabeth E Roughead
- Clinical and Health Sciences, The Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Australia.
| | - Rosanna Tavella
- Faculty of Health and Medical Sciences, The University of Adelaide, Australia.
| | - Marianne H Gillam
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
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Lin RZ, Gallagher C, Tu SJ, Pitman BM, Nelson AJ, Roberts-Thomson RL, Worthley MI, Lau DH, Sanders P, Wong CX. Trends in myocardial infarction and coronary revascularisation procedures in Australia, 1993-2017. Heart 2023; 109:283-288. [PMID: 36344268 DOI: 10.1136/heartjnl-2022-321393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Prior data have shown rising acute myocardial infarction (MI) trends in Australia; whether these increases have continued in recent years is not known. This study thus sought to characterise contemporary nationwide trends in MI hospitalisations and coronary procedures in Australia and their associated economic burden. METHODS The primary outcome measure was the incidence and time trends of total MI, ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) hospitalisations from 1993 to 2017. The incidence and time trends of coronary procedures were additionally collected, alongside MI hospitalisation costs. RESULTS Adjusted for population changes, annual MI incidence increased from 216.2 cases per 100 000 to a peak of 270.4 in 2007 with subsequent decline to 218.7 in 2017. Similarly, NSTEMI incidence increased from 68.0 cases per 100 000 in 1993 to a peak of 192.6 in 2007 with subsequent decline to 162.6 in 2017. STEMI incidence decreased from 148.3 cases per 100 000 in 1993 to 56.2 in 2017. Across the study period, there were annual increases in MI hospitalisations of 0.7% and NSTEMI hospitalisations of 5.6%, and an annual decrease in STEMI hospitalisations of 4.8%. Angiography and percutaneous coronary intervention increased by 3.4% and 3.3% annually, respectively, while coronary artery bypass graft surgery declined by 2.2% annually. MI hospitalisation costs increased by 100% over the study period, despite a decreased average length of stay by 45%. CONCLUSIONS The rising incidence of MI hospitalisations appear to have stabilised in Australia. Despite this, associated healthcare expenditure remains significant, suggesting a need for continual implementation of public health policies and preventative strategies.
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Affiliation(s)
- Richard Z Lin
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Celine Gallagher
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel J Tu
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Bradley M Pitman
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J Nelson
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Ross L Roberts-Thomson
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Dennis H Lau
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, Royal Adelaide Hospital and the University of Adelaide, Adelaide, South Australia, Australia
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Shawon MSR, Falster MO, Hsu B, Yu J, Ooi SY, Jorm L. Trends and Outcomes for Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in New South Wales from 2008 to 2019. Am J Cardiol 2023; 187:110-118. [PMID: 36459733 DOI: 10.1016/j.amjcard.2022.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/27/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022]
Abstract
Risk profiles are changing for patients who undergo percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). In Australia, little is known of the nature of these changes in contemporary practice and of the impact on patient outcomes. We identified all CABG (n = 40,805) and PCI (n = 142,399) procedures in patients aged ≥18 years in New South Wales, Australia, during 2008 to 2019. Between 2008 and 2019, the age- and gender-standardized revascularization rate increased by 20% (from 267/100,000 to 320/100,000 population) for all revascularizations. The increase in revascularization was particularly driven by a 35% increase (from 194/100,000 to 261/100,000) in PCI, whereas the rate of CABG decreased by 20% (from 73/100,000 to 59/100,000). Mean age and the prevalence of co-morbidities (especially diabetes and atrial fibrillation) increased for patients with PCI in more recent years but remained consistently lower than for patients with CABG. CABGs performed in patients presenting with a non-ST-segment-elevation acute coronary syndrome halved from 34.3% to 18.7% during the study period, whereas PCIs in this group decreased from 36.5% to 29.6%. Risk-adjusted in-hospital mortality decreased by 7.5 deaths/1,000 procedures per month for CABG but remained unchanged for PCI. Risk-adjusted readmission rates were consistently higher for CABG than for PCI and did not change significantly over time. In conclusion, we observed a dramatic shift over time from CABG to PCI as the revascularization procedure of choice, with the patient base for PCI extending to older and sicker patients. There was a large decrease in mortality after CABG, whereas mortality after PCI remained unchanged.
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Affiliation(s)
- Md Shajedur Rahman Shawon
- Centre for Big Data Research in Health (CBDRH), University of New South Wales (UNSW) Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Michael O Falster
- Centre for Big Data Research in Health (CBDRH), University of New South Wales (UNSW) Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health (CBDRH), University of New South Wales (UNSW) Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jennifer Yu
- Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia; University of New South Wales (UNSW) Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sze-Yuan Ooi
- Department of Cardiology, Prince of Wales Hospital, Sydney, New South Wales, Australia; University of New South Wales (UNSW) Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health (CBDRH), University of New South Wales (UNSW) Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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Anderson RD, Lee G, Prabhu M, Patrick CJ, Trivic I, Campbell T, Chow CK, Kalman JM, Kumar S. Ten-year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia. J Cardiovasc Electrophysiol 2019; 30:2353-2361. [PMID: 31502315 DOI: 10.1111/jce.14143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
Abstract
AIMS Major technological and procedural advancements have reinvigorated catheter ablation as adjunctive therapy for drug-refractory ventricular tachycardia (VT). We examined temporal trends in VT ablations as compared to other interventional cardiovascular procedures namely, percutaneous coronary intervention (PCI) and atrial fibrillation (AF) ablation in Australia. METHODS AND RESULTS A retrospective review of procedural numbers for VT ablations, AF ablations, and PCI was performed from 2008/09-2016/17 the Australian Institute of Health, Welfare and Aging (AIHW), and Medicare Australia (MA) databases. Linear regression models were fitted to compare the trends in population-adjusted procedural numbers over the 10-year period. Data from the AIHW and MA sources respectively showed that (a) PCI had a 1.3% (AIHW data P = .15) and 1.8% (MA data P < .001) population-adjusted increment per year, (b) AF ablations had a 12.7% (P < .001) and 11.7% (P < .001) per year population-adjusted increment, and (c) VT ablations showed an 18% (P < .001) and 12.7% (P < .001) per year population-adjusted increment. Growth of PCI was increasing at a lower rate than AF ablations (P < .001 for both AIHW and MA sources). Growth of VT ablation was significantly higher than AF ablations and PCI (AIHW: 18% vs 12.7% [P = .004] and 1.3% per year [P < .001]). CONCLUSION Catheter-based VT ablation has increased significantly in Australia over the last decade, consistent with worldwide trends, and now surpassing all ablation procedures, including AF ablation and PCI for CAD. This data highlight the provision of additional resources to match the increasing demand for VT ablation procedures in Australia.
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Affiliation(s)
- Robert D Anderson
- Department of Cardiology, Faculty of Medicine, Dentistry, and Health Science, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey Lee
- Department of Cardiology, Faculty of Medicine, Dentistry, and Health Science, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Mukund Prabhu
- Department of Cardiology, Faculty of Medicine, Dentistry, and Health Science, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Cameron J Patrick
- Department of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Faculty of Medicine, Dentistry, and Health Science, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
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Yan BP, Chan LLY, Lee VWY, Yu CM, Wong MCS, Sanderson J, Reid CM. Sustained 3-Year Benefits in Quality of Life After Percutaneous Coronary Interventions in the Elderly: A Prospective Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:423-431. [PMID: 29680099 DOI: 10.1016/j.jval.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Impact of percutaneous coronary interventions (PCI) on health-related quality of life (HRQOL) is important but under-reported in elderly patients. OBJECTIVES To evaluate long-term health status in elderly patients who underwent PCI. METHODS Consecutive patients who underwent PCI at a university-affiliated hospital from September 2009 to June 2012 were prospectively enrolled with HRQOL assessment at baseline (up to 2 weeks before PCI) and at 6-, 12-, and 36-month follow-up using the EuroQol five-dimensional questionnaire descriptive profile and visual analogue scale (VAS). Minimally important benefit (MIB) in HRQOL was defined as greater than half an SD improvement in the baseline VAS score. RESULTS Of 1957 patients, 49.9%, 29.1%, and 21.0% were aged younger than 65 years, 65 to 74 years, and 75 years and older, respectively. Mean VAS scores at baseline (50.1 ± 20.5 vs. 51.6 ± 20.5 vs. 52.6 ± 21.8; P = 0.09) and at 36 months (72.9 ± 14.0 vs. 72.8 ± 16.1 vs. 72.0 ± 14.8; P = 0.77) were similar between the three age groups, respectively. MIB at 36 months was observed in 65.7%, 61.9%, and 61.2% of patients in each age group, respectively. Proportion of patients aged 75 years and older reporting problems in pain/discomfort and self-care reduced from 91.2% and 24.8% at baseline to 41.4% and 10.1% at 36 months, respectively (both P < 0.01). Independent predictors of MIB in HRQOL at 36 months in patients 75 years and older included poor baseline HRQOL, MIB at 6 months, and presentation with myocardial infarction (all P < 0.01). CONCLUSIONS Elderly patients experienced sustained long-term improvement in quality of life comparable with younger patients after PCI. Our findings suggest that age per se should not deter against revascularization because of sustained benefit in HRQOL.
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Affiliation(s)
- Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong; Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia.
| | - Lally L Y Chan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Vivian W Y Lee
- School of Pharmacy, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - John Sanderson
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital and Institute of Vascular Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Christopher M Reid
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, Australia
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Chen D, Jepson N. Coronary stent technology: a narrative review. Med J Aust 2016; 205:277-81. [DOI: 10.5694/mja16.00444] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
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Chan MY, Du X, Eccleston D, Ma C, Mohanan PP, Ogita M, Shyu KG, Yan BP, Jeong YH. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol 2016; 202:861-9. [DOI: 10.1016/j.ijcard.2015.04.073] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
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Martin L, Murphy M, Scanlon A, Clark D, Farouque O. The impact on long term health outcomes for STEMI patients during a period of process change to reduce door to balloon time. Eur J Cardiovasc Nurs 2015; 15:e37-44. [PMID: 25784283 DOI: 10.1177/1474515115577294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/22/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Guidelines for the management of ST-segment elevation myocardial infarction (STEMI) recommend a 'door to balloon time' (DTBT) within 90 minutes. It is unclear whether strategies to reduce DTBT translate to improved longer-term health outcomes for STEMI patients. AIMS This study sought to determine whether implemented strategies to improve timely management of STEMI reduced DTBT and impacted upon health outcomes such as length of stay, unplanned readmission and 12-month mortality. Predictors of timely management for STEMI were also examined. METHODS A five-year review was undertaken on primary percutaneous coronary intervention for STEMI in one tertiary hospital. Comparisons were made between process change groups and DTBT. Logistic regression identified predictors of timely management. RESULTS 470 STEMI patients underwent immediate primary percutaneous coronary intervention. Process change improved the median DTBT (109 min vs. 72 min, p<0.001) with no significant effect on length of stay (p=0.83), unplanned cardiac readmissions (p=0.68) or 12-month mortality (9.0% vs. 8.6%, p=0.64). Those receiving timely treatment (i.e. DTBT< 90 min) were younger (p<0.05), male (p<0.03), presented via ambulance (p<0.004), during business hours (p<0.0001) and had a lower Thrombolysis In Myocardial Infarction score (p<0.006). Timely treatment was associated with lower 12-month mortality (3.7% vs. 15.7%, p<0.0001) and increased uptake of inpatient cardiac rehabilitation (p<0.005), with length of stay and unplanned readmission similar between groups (p=NS). CONCLUSIONS Process changes improved DTBT but had no effect on length of stay, readmission rate or 12-month mortality. Yet, timely management was critical to 12-month outcomes. Further studies are required to explore the barriers to timely treatment.
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Affiliation(s)
- Lorelle Martin
- LaTrobe University School of Nursing, Melbourne, Australia Department of Cardiology, Austin Health, Heidelberg, Australia
| | - Maria Murphy
- LaTrobe University School of Nursing, Melbourne, Australia Department of Cardiology, Austin Health, Heidelberg, Australia
| | - Andrew Scanlon
- LaTrobe University School of Nursing, Melbourne, Australia
| | - David Clark
- LaTrobe University School of Nursing, Melbourne, Australia
| | - Omar Farouque
- LaTrobe University School of Nursing, Melbourne, Australia
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Fefer P, Gannot S, Lubetsky A, Martinowitz U, Matetzky S, Guetta V, Segev A. Percutaneous coronary intervention in patients with haemophilia presenting with acute coronary syndrome: an interventional dilemma: case series, review of the literature, and tips for management. J Thromb Thrombolysis 2013; 35:271-8. [PMID: 22956409 DOI: 10.1007/s11239-012-0802-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Since the introduction of clotting factor concentrates over 50 years ago the life expectancy of patients with hemophilia (PWH) has increased to over 70 years. Consequently, diseases of the ageing population, including coronary artery disease, are increasingly being encountered. These patients present a unique therapeutic problem due to their greatly increased bleeding risk. Randomized controlled studies specific to PWH are lacking, emphasizing the need for case series. We present three cases of acute coronary syndrome in PWH who underwent urgent percutaneous coronary intervention at our institution, and summarize the available literature on the topic. We describe their management and outcome and provide points to consider when treating these complex patients.
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Affiliation(s)
- Paul Fefer
- Leviev Heart Center, Sheba Medical Center and Tel Aviv University, Tel Hashomer, Israel.
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Management of Acute Coronary Syndromes in Patients with Diabetes: Implications of the FREEDOM Trial. Clin Ther 2013; 35:1069-75. [DOI: 10.1016/j.clinthera.2013.07.427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
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Benefits and risks of long-term duration of dual antiplatelet therapy after drug-eluting stenting: a meta-analysis of randomized trials. Int J Cardiol 2013; 168:2579-87. [PMID: 23590932 DOI: 10.1016/j.ijcard.2013.03.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/03/2012] [Accepted: 03/17/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The potential benefits and risks of at least 1-year dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) implantation remain uncertain. METHODS AND RESULTS PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched from database inception to December 2011 for randomized controlled trials that compared longer DAPT versus shorter DAPT duration after DES. Unpublished data were obtained from investigators. Trial-specific odds ratios (ORs) with 95% confidence interval (CI) were calculated and pooled using fixed-effects or random-effects model as appropriate. Data were independently extracted by 2 reviewers. Three randomized controlled trials comprising 5622 participants were included. Compared with patients receiving short-term therapy, participants receiving longer DAPT duration had a pooled OR of 1.26 (95% CI, 0.88 to 1.80; P=0.21, random-effects) for the primary outcome of cardiac death, myocardial infarction or stroke, OR of 1.29 (95% CI, 0.85 to 1.93; fixed-effects) for all-cause death, 1.23 (95% CI, 0.78 to 1.93; fixed-effects) for cardiac death, 0.91 (95% CI, 0.58 to 1.42; random-effects) for myocardial infarction, 1.93 (95% CI, 1.01 to 3.69; fixed-effects) for stroke and 2.51 (95% CI, 1.10 to 5.71, fixed-effects) for TIMI major bleeding. The number needed to treat for an additional harmful outcome was 217.6 for stroke and 243 for TIMI major bleeding. CONCLUSIONS This meta-analysis provides no evidence of benefits with longer DAPT duration as compared with a shorter course of therapy. It also reports significant harms with respect to major bleeding and stroke associated with prolonged DAPT use.
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Vallely MP, Edelman JJB. Anaortic, off-pump coronary artery surgery: should it be the standard-of-care? Interv Cardiol 2013. [DOI: 10.2217/ica.13.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Edelman JJB, Wilson MK, Bannon PG, Vallely MP. Cardiac surgery versus stenting: what is better for the patient? ANZ J Surg 2012; 82:792-8. [DOI: 10.1111/j.1445-2197.2012.06262.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 11/30/2022]
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