The changing face of coronary interventional practice - The Mayo Clinic experience

Background: Devices designed to facilitate or replace conventional percutaneous transluminal coronary angioplasty have been introduced in recent years. Objectives: To characterize the changes in percutaneous coronary interventional practice over 16 years and to assess the relative use of these new devices. Methods: We performed a retrospective analysis of all patients who underwent percutaneous coronary revascularization at Mayo Clinic, Rochester, Minn, during a 16-year period (1980-1995) and characterized the changes in procedural and clinical factors. Results: The number of coronary interventional procedures performed increased from 38 in 1980 to 1284 in 1995. Atherectomy and laser angioplasty were incorporated in 1988; their use peaked in 1994 (17% of procedures) but decreased to 9.9% by 1995. In contrast, the use of intracoronary stents has increased steadily since 1990. By 1995, intracoronary stents were placed in 48.2% of procedures. The success rate improved from 55.3% in 1980 to 91.4% in 1995, although patients were older (51+/-10 [mean+/-SD] years in 1980 vs 63+/-12 years in 1995), had more extensive coronary artery disease (0% with multivessel disease in 1980 vs 47.4% in 1995),had more complex lesions, and often underwent intervention in the peri-infarction setting (2.6% of procedures in 1980 vs 17% in 1995). The rate of referral to emergency coronary bypass surgery after percutaneous procedures declined from 5.2% in 1980 to 0.4% in 1995. Conclusions: Current coronary interventional practice is expanding and improving. In contrast to intracoronary stents that have greatly affected current practice, other new devices are used infrequently. Conventional angioplasty, with or without intracoronary stents, remains the dominant treatment strategy.