Interinstitutional variation in the use of abciximab for percutaneous coronary intervention.
BACKGROUND: Several clinical trials have established abciximab as an efficacious agent for use in conjunction with percutaneous coronary intervention; however, there is little documented about its use in routine clinical practice in Canada. OBJECTIVES: To determine the use of abciximab, and secondarily, its associations with one-year death and repeat revascularization rates in 2751 Alberta residents who underwent percutaneous coronary intervention in 1999. METHODS: Descriptive statistics were used to determine use patterns. Logistic regression models were used to define risk of long-term outcomes and to determine associations between abciximab use and risk-adjusted death and repeat revascularization rates. RESULTS: Abciximab was administered to 43.5% of the study population and interinstitutional differences were revealed (site A, 46.7%; site B, 26.6%; site C, 54.6%, P<0.001). Use patterns according to the adjusted risk of death or repeat revascularization also differed across these sites. There were no differences between patients treated with versus those treated without abciximab in risk-adjusted one-year mortality (3.7%, 95% CI 2.8% to 3.7% versus 3.1%, 95% CI 2.3% to 4.0%) or revascularization rates (16.7%, 95% CI 14.8% to 19.1% versus 15.8%, 95% CI 14.0% to 17.7%). However, differences in baseline clinical characteristics between these two groups may limit the inferences that can be made from these outcome comparisons. CONCLUSIONS: Use patterns varied across the tertiary care hospitals in Alberta and the use of abciximab was not associated with reduced rates of long term death or repeat revascularization. The absence of provincial or national guidelines may have influenced the uptake and application of this novel therapy.
Westerhout, CM; Saunders, LD; Kaul, P; Armstrong, PW; Knudtson, ML; Ghali, WA
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