The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Temporal trends in clinical outcomes after percutaneous coronary intervention: a systematic review of 66,327 patients from 25 all-comers trials

DOI: 10.4244/EIJ-D-21-00192

1. Department of Cardiovascular Medicine, St. Luke’s International Hospital, St. Luke’s International University, Tokyo, Japan; 2. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 3. Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland; 4. Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 5. The Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA; 6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 7. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; 8. Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan

Background: With the improvements of percutaneous coronary intervention (PCI) technology and post-PCI patient management, several registry studies reported temporal trends in post-PCI clinical outcomes. However, their results are inconclusive, potentially reflecting region-specific trends, based on site-reported events without external validity.

Aims: This study aimed to investigate temporal trends in post-PCI clinical outcomes in all-comers randomised controlled trials (RCTs) involving coronary stents.

Methods: We performed a systematic review identifying RCTs comparing a clinical outcome as a primary endpoint among different coronary stents with an all-comers design and independent clinical event adjudication, extracting the study start year, patient baseline characteristics, and one- and five-year clinical outcomes. Temporal trends in clinical outcomes (cardiac death, myocardial infarction [MI], target lesion revascularisation [TLR], stent thrombosis [ST]) were assessed using random-effects meta-regression analyses, estimating the relationship between clinical outcomes and study start year.

Results: Overall, 25 all-comers trials (51 device arms, 66,327 patients) conducted between 2003 and 2018 fulfilled the eligibility criteria. Random-effects meta-regression analysis revealed significant decreasing trends in one- and five-year cardiac death, one-year TLR, and five-year ST incidences (relative risk per 10-year increase: 0.69 [0.51-0.92], 0.66 [0.44-0.98], 0.60 [0.41-0.88], and 0.18 [0.07-0.44], respectively). There was no significant trend in myocardial infarction incidences.

Conclusions: This is the first attempt to clarify and quantify the temporal trends of post-PCI outcome incidence. The 15-year improvements in PCI therapy and post-therapeutic patient management are associated with reduced incidences of cardiac death and PCI-related adverse events.

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