Twenty-Five–Year Trends in In-Hospital and Long-Term Outcome After Percutaneous Coronary Intervention: A Single-Institution Experience

Background— Little is known about the impact of technological and pharmacological advances on long-term outcome after percutaneous coronary intervention in general clinical practice. Methods and Results— We analyzed in-hospital and long-term outcome of 24 410 percutaneous coronary interventions among 18 575 unique patients who underwent percutaneous coronary intervention at Mayo Clinic over 25 years. The study population was divided into group 1 (n=3708), coronary interventions from 1979 to 1989; group 2 (n=7020), interventions from 1990 to 1996; group 3 (n=10 952), interventions from 1996 to 2003; and group 4 (n=2730), interventions from 2003 to 2004. Despite the fact that patients in groups 3 and 4 were significantly older, sicker, and had greater prevalence of comorbid conditions, heart failure, and previous revascularization than those in groups 1 and 2, procedural success in groups 3 and 4 improved significantly (94%) versus groups 2 (89%) and 1 (78%) (P<0.001). Significant reduction in in-hospital mortality (groups 4 to 1: 1.8%, 1.7%, 2.6%, 3.0%; P<0.001) and need for emergency bypass surgery (groups 4 to 1: 0.4%, 0.5%, 1.6%, 5%; P<0.001) was noted in groups 3 and 4 compared with groups 1 and 2. Better adherence to currently recommended evidence-based medications for secondary prevention was seen in the recent time periods. After adjustment, significant reduction in follow-up mortality (hazard ratio, 0.81 and 0.74 for groups 3 and 4, respectively); death or myocardial infarction (hazard ratio, 0.80 and 0.75 for groups 3 and 4, respectively); death, myocardial infarction, or revascularization (hazard ratio, 0.76 and 0.58 for groups 3 and 4, respectively) was noted in recent time periods. Conclusions— Despite higher-risk profiles of patients who underwent percutaneous coronary intervention in recent time periods, procedural success as well as in-hospital and long-term outcomes improved significantly over the last 25 years.

[1]  P. Molina,et al.  High-resolution CT of patients with primary ciliary dyskinesia. , 2007, AJR. American journal of roentgenology.

[2]  H. Omran,et al.  Mutations of DNAI1 in primary ciliary dyskinesia: evidence of founder effect in a common mutation. , 2006, American journal of respiratory and critical care medicine.

[3]  Rodney A. White,et al.  ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Intervent , 2006, Journal of vascular and interventional radiology : JVIR.

[4]  S. Antonarakis,et al.  DNAH5 mutations are a common cause of primary ciliary dyskinesia with outer dynein arm defects. , 2006, American journal of respiratory and critical care medicine.

[5]  Jeroen J. Bax,et al.  Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. , 2006, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[6]  W. Aronow,et al.  Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins. , 2006, The American journal of cardiology.

[7]  J. Wirbelauer,et al.  Heterotaxy Syndrome – Asplenia and Polysplenia as Indicators of Visceral Malposition and Complex Congenital Heart Disease , 2005, Neonatology.

[8]  D. Holmes,et al.  Application of evidence-based medical therapy is associated with improved outcomes after percutaneous coronary intervention and is a valid quality indicator. , 2005, Journal of the American College of Cardiology.

[9]  B. McCrindle,et al.  Clinical Features, Management, and Outcome of Children With Fetal and Postnatal Diagnoses of Isomerism Syndromes , 2005, Circulation.

[10]  M Egger,et al.  The causes and effects of socio-demographic exclusions from clinical trials. , 2005, Health technology assessment.

[11]  E. Chan,et al.  A Middle-Aged Woman with Recurrent Respiratory Infections , 2005, Respiration.

[12]  H. Omran,et al.  Mislocalization of DNAH5 and DNAH9 in respiratory cells from patients with primary ciliary dyskinesia. , 2005, American journal of respiratory and critical care medicine.

[13]  K J Millen,et al.  The ZIC gene family in development and disease , 2005, Clinical genetics.

[14]  H. Firth,et al.  Fetal cardiac anomalies and genetic syndromes , 2004, Prenatal diagnosis.

[15]  S. Weiss,et al.  Gender Differences in Experimental Aortic Aneurysm Formation , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[16]  N. Heintz,et al.  Dysfunction of axonemal dynein heavy chain Mdnah5 inhibits ependymal flow and reveals a novel mechanism for hydrocephalus formation. , 2004, Human molecular genetics.

[17]  D. Baim,et al.  Beyond Restenosis: Five-Year Clinical Outcomes From Second-Generation Coronary Stent Trials , 2004, Circulation.

[18]  G. Ailawadi,et al.  Gender differences in rat aortic smooth muscle cell matrix metalloproteinase-9. , 2004, Journal of the American College of Surgeons.

[19]  M. Hazucha,et al.  Primary ciliary dyskinesia: diagnostic and phenotypic features. , 2004, American journal of respiratory and critical care medicine.

[20]  Stephen W. Daunt,et al.  Age-related normal ranges for the Haller index in children , 2004, Pediatric Radiology.

[21]  K. Detre,et al.  Validation of Mayo Clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry. , 2003, Journal of the American College of Cardiology.

[22]  M. Brueckner,et al.  Cilia are at the heart of vertebrate left-right asymmetry. , 2003, Current opinion in genetics & development.

[23]  T. Strachan,et al.  Mutations in INVS encoding inversin cause nephronophthisis type 2, linking renal cystic disease to the function of primary cilia and left-right axis determination , 2003, Nature Genetics.

[24]  D. Nelson,et al.  Smokers' relative risk for aortic aneurysm compared with other smoking-related diseases: a systematic review. , 2003, Journal of vascular surgery.

[25]  M. Brueckner,et al.  Two Populations of Node Monocilia Initiate Left-Right Asymmetry in the Mouse , 2003, Cell.

[26]  P. Greenland,et al.  Middle Age Cardiovascular Risk Factors and Abdominal Aortic Aneurysm in Older Age , 2003, Hypertension.

[27]  T. Länne,et al.  Noninvasive ultrasound measurements of aortic intima-media thickness: implications for in vivo study of aortic wall stress. , 2003, Journal of vascular surgery.

[28]  S. Al-Ali,et al.  Isomerism of the right atrial appendages: Clinical, anatomical, and microscopic study of a long‐surviving case with asplenia and ciliary abnormalities , 2003, Clinical anatomy.

[29]  R. Frye,et al.  Burgeoning dilemmas in the management of diabetes and cardiovascular disease: rationale for the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial. , 2003, Circulation.

[30]  Gerard Tromp,et al.  Familial abdominal aortic aneurysms: collection of 233 multiplex families. , 2003, Journal of vascular surgery.

[31]  C. Loffredo,et al.  Risk factors for heart disease associated with abnormal sidedness. , 2002, Teratology.

[32]  S. Ellis,et al.  Emergency Coronary Artery Bypass Surgery in the Contemporary Percutaneous Coronary Intervention Era , 2002, Circulation.

[33]  M. Bell,et al.  Correlates of procedural complicationsand a simple integer risk scorefor percutaneous coronary intervention , 2002 .

[34]  Y. Saijoh,et al.  Determination of left–right patterning of the mouse embryo by artificial nodal flow , 2002, Nature.

[35]  A. Bush,et al.  Primary ciliary dyskinesia: age at diagnosis and symptom history , 2002, Acta paediatrica.

[36]  Samuel E. Wilson,et al.  Immediate repair compared with surveillance of small abdominal aortic aneurysms. , 2002, The New England journal of medicine.

[37]  C. Zarins,et al.  Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. , 2002, Journal of vascular surgery.

[38]  N. Heintz,et al.  Loss of function of axonemal dynein Mdnah5 causes primary ciliary dyskinesia and hydrocephalus. , 2002, Human molecular genetics.

[39]  D. Holmes,et al.  Influence of coronary thrombus on outcome of percutaneous coronary angioplasty in the current era (the Mayo Clinic experience). , 2001, American Journal of Cardiology.

[40]  B. Katzen,et al.  The influence of female gender on the outcome of endovascular abdominal aortic aneurysm repair. , 2001, Journal of vascular and interventional radiology : JVIR.

[41]  J. K. Lee,et al.  Experimental Abdominal Aortic Aneurysms in Mice Lacking Expression of Inducible Nitric Oxide Synthase , 2001, Arteriosclerosis, thrombosis, and vascular biology.

[42]  Y. Itzchak,et al.  CT findings in congenital anomalies of the spleen. , 2001, The British journal of radiology.

[43]  A. Aylsworth.  Clinical aspects of defects in the determination of laterality. , 2001, American journal of medical genetics.

[44]  S. Wilson,et al.  Abdominal aortic aneurysm in women. , 2001, Journal of vascular surgery.

[45]  A. Jacobs,et al.  Percutaneous Coronary Intervention in the Current Era Compared With 1985–1986: The National Heart, Lung, and Blood Institute Registries , 2000, Circulation.

[46]  W. Williams,et al.  Outcomes of left atrial isomerism over a 28-year period at a single institution. , 2000, Journal of the American College of Cardiology.

[47]  M. Lewin.  The genetic basis of congenital heart disease. , 2000, Pediatric annals.

[48]  S. Shapiro,et al.  Targeted gene disruption of matrix metalloproteinase-9 (gelatinase B) suppresses development of experimental abdominal aortic aneurysms. , 2000, The Journal of clinical investigation.

[49]  L. Holmes,et al.  Heterotaxy: Associated conditions and hospital-based prevalence in newborns , 2000, Genetics in Medicine.

[50]  M. Bell,et al.  Effect of age on the outcome of angioplasty for acute myocardial infarction among patients treated at the Mayo Clinic. , 2000, The American journal of medicine.

[51]  D. Holmes,et al.  Percutaneous coronary interventions in patients with prior coronary artery bypass surgery: changes in patient characteristics and outcome during two decades. , 2000, The American journal of medicine.

[52]  S. Kimmel,et al.  Contemporary trends in coronary intervention: A report from the registry of the Society for Cardiac Angiography and Interventions , 2000, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[53]  N. Hirokawa,et al.  Randomization of Left–Right Asymmetry due to Loss of Nodal Cilia Generating Leftward Flow of Extraembryonic Fluid in Mice Lacking KIF3B Motor Protein , 1999, Cell.

[54]  T. Ryan,et al.  Changing outcomes in percutaneous coronary interventions: a study of 34,752 procedures in northern New England, 1990 to 1997. Northern New England Cardiovascular Disease Study Group. , 1999, Journal of the American College of Cardiology.

[55]  H. White,et al.  Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. , 1999, The New England journal of medicine.

[56]  M. Morice,et al.  Emergency coronary artery bypass surgery following coronary angioplasty and stenting: Results of a French multicenter registry , 1999, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[57]  M. Amitai,et al.  Polysplenia syndrome detected in adulthood: report of eight cases and review of the literature , 1999, Abdominal Imaging.

[58]  L. Ostrowski,et al.  Discordant organ laterality in monozygotic twins with primary ciliary dyskinesia. , 1999, American journal of medical genetics.

[59]  C. Holman,et al.  The Quality of Surgical Care Project: benchmark standards of open resection for abdominal aortic aneurysm in Western Australia. , 1998, The Australian and New Zealand journal of surgery.

[60]  K. Yunis,et al.  Dextrocardia and corrected transposition of the great arteries (I, D, D) in a case of kartagener's syndrome: A unique association , 1998, Clinical cardiology.

[61]  D. Supp,et al.  Mutation of an axonemal dynein affects left–right asymmetry in inversus viscerum mice , 1997, Nature.

[62]  T. Stati,et al.  Sonographic survey of the upper abdomen in 10 families of patients with immotile cilia syndrome , 1997, Journal of clinical ultrasound : JCU.

[63]  L. Pointon,et al.  Co-Morbidity in Patients with Abdominal Aortic Aneurysm , 1996, Journal of medical screening.

[64]  M. Turina,et al.  Kartagener's syndrome: clinical presentation and cardiosurgical aspects. , 1996, The Annals of thoracic surgery.

[65]  E. Mascha,et al.  Influence of gender on cardiac risk and survival in patients with infrarenal aortic aneurysms. , 1996, Journal of vascular surgery.

[66]  C. Phoon,et al.  Asplenia syndrome--risk factors for early unfavorable outcome. , 1994, The American journal of cardiology.

[67]  J. Warner,et al.  New associations of primary ciliary dyskinesia syndrome , 1993, Pediatric pulmonology.

[68]  J. Icardo,et al.  Spectrum of Heart Malformations in Mice With Situs Solitus, Situs Inversus, and Associated Visceral Heterotaxy , 1991, Circulation.

[69]  H. Winer-Muram,et al.  The spectrum of heterotaxic syndromes. , 1989, Radiologic clinics of North America.

[70]  R. Gershoni-baruch,et al.  Immotile cilia syndrome including polysplenia, situs inversus, and extrahepatic biliary atresia. , 1989, American journal of medical genetics.

[71]  J. Vacek,et al.  Prolonged and functional survival with the asplenia syndrome. , 1986, The American journal of medicine.

[72]  H. Levison,et al.  The immotile cilia syndrome: radiological manifestations. , 1985, Radiology.

[73]  J. Moller,et al.  Polysplenia: A review of 146 cases , 1983, Pediatric Cardiology.

[74]  J. Markowitz,et al.  Abnormal cilia in a child with the polysplenia syndrome and extrahepatic biliary atresia. , 1982, The Journal of pediatrics.

[75]  S. M. Katz,et al.  Polysplenia and kartagener syndromes in a sibship: association with abnormal respiratory cilia. , 1982, The Journal of pediatrics.

[76]  W. Siegenthaler,et al.  Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. , 1979, The New England journal of medicine.

[77]  B. Afzelius.  A human syndrome caused by immotile cilia. , 1976, Science.

[78]  J. Moller,et al.  Congenital Cardiac Disease Associated with Polysplenia: A Developmental Complex of Bilateral “Left‐Sidedness” , 1967, Circulation.

[79]  B. Ivemark.  Implications of Agenesis of the Spleen on the Pathogenesis of Conotruncus Anomalies in Childhood , 1955, Acta paediatrica. Supplementum.

[80]  J. Belmont,et al.  Genetics of human heterotaxias , 2006, European Journal of Human Genetics.

[81]  Brenda S. Cho,et al.  Tamoxifen up-regulates catalase production, inhibits vessel wall neutrophil infiltration, and attenuates development of experimental abdominal aortic aneurysms. , 2005, Journal of vascular surgery.

[82]  A. Eroğlu,et al.  Pectus excavatum and situs inversus totalis: a new combination or a coincidence? , 2004, Genetic counseling.

[83]  A. Daugherty,et al.  Abdominal Aortic Aneurysms : Pathophysiological Mechanisms and Clinical Implications , 2004 .

[84]  M. Bell,et al.  Correlates of procedural complications and a simple integer risk score for percutaneous coronary intervention. , 2002, Journal of the American College of Cardiology.

[85]  H. S,et al.  Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock , 2000 .

[86]  S. Iliceto,et al.  Interrupted inferior vena cava in asplenia syndrome and a review of the hereditary patterns of visceral situs abnormalities. , 1998, The American journal of cardiology.

[87]  E. Kazam,et al.  Aortic aneurysmal disease in women. Is there a greater incidence of suprarenal involvement? , 1996, Annals of the New York Academy of Sciences.

[88]  J. Mead,et al.  Rib cage mobility in pectus excavatum. , 1985, The American review of respiratory disease.