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Rates of elective percutaneous coronary intervention in England and Wales: impact of COURAGE and ORBITA trials

Rates of elective percutaneous coronary intervention in England and Wales: impact of COURAGE and ORBITA trials
Rates of elective percutaneous coronary intervention in England and Wales: impact of COURAGE and ORBITA trials
Background:
There are limited data about how COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) and ORBITA (Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) trials have impacted percutaneous coronary intervention (PCI) practices at regional or national level. We evaluated temporal trends in elective PCI rates for stable angina and, specifically, examined the impact of the COURAGE and ORBITA trials on PCI practices in England and Wales.
Methods and Results:
We used national PCI data comprising >1.2 million patients undergoing PCI between January 2006 and December 2019. Patient demographics, procedural details, and clinical outcomes were analyzed, and temporal trends in PCI rates for stable angina were compared before and after the publication of the COURAGE and ORBITA trials. Of 1 245 802 PCI procedures, 430 248 (34.5%) were performed for stable angina. Over the study period, the number of elective PCI procedures per year (30 823 in 2006 to 34 103 in 2019) and per 100 000 population estimates (50.7 in 2006 to 58.4 in 2019) remained stable. The proportion of patients undergoing elective PCI without angina symptoms almost doubled from 5.1% to 9.7%. The incidence rate of elective PCI volume after the COURAGE trial, published in 2007, was not different from before the trial was published (incidence rate ratio, 1.06 [95% CI, 0.69–1.62]). It also remained stable after the publication of the ORBITA trial in 2017 (incidence rate ratio, 0.96 [95% CI, 0.74–1.23]).
Conclusions:
In this nationwide analysis, rates of elective PCI for stable angina remained stable over 14 years. Publication of the COURAGE and ORBITA trials had no impact on elective PCI activity.
Rashid, M
919dbd62-f042-4d86-9c30-d5ddf085ea46
Stevens, C
77f61a77-69d2-467e-ad5f-b4e03e648cfb
Wijeysundera, HC
25b9f9b5-666d-4bd4-9930-6a10ad11c83f
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Rashid, M
919dbd62-f042-4d86-9c30-d5ddf085ea46
Stevens, C
77f61a77-69d2-467e-ad5f-b4e03e648cfb
Wijeysundera, HC
25b9f9b5-666d-4bd4-9930-6a10ad11c83f
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4

Rashid, M, Stevens, C, Wijeysundera, HC and Curzen, Nick (2022) Rates of elective percutaneous coronary intervention in England and Wales: impact of COURAGE and ORBITA trials. Journal of the American Heart Association, 11 (18), [e025426]. (doi:10.1161/JAHA.122.025426).

Record type: Article

Abstract

Background:
There are limited data about how COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) and ORBITA (Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) trials have impacted percutaneous coronary intervention (PCI) practices at regional or national level. We evaluated temporal trends in elective PCI rates for stable angina and, specifically, examined the impact of the COURAGE and ORBITA trials on PCI practices in England and Wales.
Methods and Results:
We used national PCI data comprising >1.2 million patients undergoing PCI between January 2006 and December 2019. Patient demographics, procedural details, and clinical outcomes were analyzed, and temporal trends in PCI rates for stable angina were compared before and after the publication of the COURAGE and ORBITA trials. Of 1 245 802 PCI procedures, 430 248 (34.5%) were performed for stable angina. Over the study period, the number of elective PCI procedures per year (30 823 in 2006 to 34 103 in 2019) and per 100 000 population estimates (50.7 in 2006 to 58.4 in 2019) remained stable. The proportion of patients undergoing elective PCI without angina symptoms almost doubled from 5.1% to 9.7%. The incidence rate of elective PCI volume after the COURAGE trial, published in 2007, was not different from before the trial was published (incidence rate ratio, 1.06 [95% CI, 0.69–1.62]). It also remained stable after the publication of the ORBITA trial in 2017 (incidence rate ratio, 0.96 [95% CI, 0.74–1.23]).
Conclusions:
In this nationwide analysis, rates of elective PCI for stable angina remained stable over 14 years. Publication of the COURAGE and ORBITA trials had no impact on elective PCI activity.

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More information

Accepted/In Press date: 26 July 2022
Published date: 20 September 2022
Additional Information: Rashid M, Stevens C, Wijeysundera HC, Curzen N, Khoo CW, Mohamed MO, Aktaa S, Wu J, Ludman PF, Mamas MA. Rates of Elective Percutaneous Coronary Intervention in England and Wales: Impact of COURAGE and ORBITA Trials. J Am Heart Assoc. 2022 Sep 20;11(18):e025426. doi: 10.1161/JAHA.122.025426. Epub 2022 Sep 14. PMID: 36102261

Identifiers

Local EPrints ID: 492390
URI: http://eprints.soton.ac.uk/id/eprint/492390
PURE UUID: 2fa0fb07-4453-4344-832d-6e86b54809a8
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 25 Jul 2024 16:58
Last modified: 26 Jul 2024 01:40

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Contributors

Author: M Rashid
Author: C Stevens
Author: HC Wijeysundera
Author: Nick Curzen ORCID iD

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