Antianginal therapy before percutaneous coronary intervention.
Journal Article
Background
The regional variability of percutaneous coronary intervention (PCI) rates may be explained by variations in the medical treatment of stable coronary artery disease. We sought to determine whether greater regional use of antianginal medications in PCI patients is associated with lower regional rates of PCI.Methods and results
Using CathPCI Registry and Dartmouth Atlas data, we examined patients undergoing elective PCI for stable coronary artery disease from January 1, 2009, through March 31, 2011, and calculated rates of providing ≥ 2 antianginal medicines before PCI. We regressed the hospital referral region rates of PCI per 1000 Medicare enrollees in 2007 on the regions' rates of providing ≥ 2 antianginal medications before PCI. Among 300772 PCI procedures, 32.8%, 48.3%, 16.1%, and 2.8% of patients were on 0, 1, 2, or ≥ 3 antianginal medications, respectively. The median rate of providing ≥ 2 antianginal medications before PCI was 18.9%. Although substantial variability existed across hospital referral regions in providing ≥ 2 antianginal medications and in rates of PCI from the Dartmouth Atlas, there was no association between the rates of PCI in each hospital referral region and the rates of ≥ 2 antianginal medications before PCI (Spearman ρ, 0.0277; P=0.64).Conclusions
We found no association between the intensity of antianginal therapy and the use of PCI across hospital referral regions, despite the variability of both. Opportunities likely exist in many regions to increase the use of antianginal therapy before proceeding to elective PCI, and more research is needed to explain observed variations in care.Full Text
Duke Authors
Cited Authors
- Borden, WB; Spertus, JA; Mushlin, AI; Roe, MT; McCoy, LA; Redberg, RF
Published Date
- August 6, 2013
Published In
Volume / Issue
- 6 / 4
Start / End Page
- 436 - 443
PubMed ID
- 23922143
Pubmed Central ID
- 23922143
Electronic International Standard Serial Number (EISSN)
- 1941-7632
International Standard Serial Number (ISSN)
- 1941-7640
Digital Object Identifier (DOI)
- 10.1161/circinterventions.112.000215
Language
- eng