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Original Articles

Temporal Changes in the Use of Drug-Eluting Stents for Patients With Non–ST-Segment–Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention From 2006 to 2008

Results From the Can Rapid risk stratification of Unstable angina patients Supress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) and Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines (ACTION–GWTG) Registries

Matthew T. Roe, MD, MHS; Anita Y. Chen, MS; Christopher P. Cannon, MD; Sunil Rao, MD; John Rumsfeld, MD, PhD; David J. Magid, MD, MPH; Ralph Brindis, MD, MPH; Lloyd W. Klein, MD; W. Brian Gibler, MD; E. Magnus Ohman, MD; Eric D. Peterson, MD, MPH on behalf of the CRUSADE and ACTION–GWTG Registry Participants

From the Duke Clinical Research Institute (M.T.R., A.Y.C., S.R., E.M.O., E.D.P.), Duke University Medical Center, Durham, NC; TIMI Study Group (C.P.C.), Brigham and Women’s Hospital, Boston, Mass; Denver VA Medical Center (J.R.), Denver, Colo; the Institute for Health Research (D.J.M.), Kaiser Permanente Colorado, and the Departments of Emergency Medicine and Preventive Medicine and Biometrics (D.J.M.), University of Colorado Health Science Center, Denver; Kaiser Permanente Health System (R.B.), San Francisco, Calif; Rush Medical College (L.W.K.), Chicago, Ill; and the University of Cincinnati College of Medicine (W.B.G.), Cincinnati, Ohio.

Correspondence to Matthew T. Roe, MD, MHS, 2400 Pratt St, Room 7035, Durham, NC 27705. E-mail matthew.roe{at}duke.edu

Received January 12, 2009; accepted June 10, 2009.

Background— The risks of late stent thrombosis with drug-eluting stents (DES) were intensely debated after the presentation of a number of studies highlighting this issue in September 2006. We evaluated trends in the use of DES for patients with non–ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) from 2006 to 2008.

Methods and Results— Temporal patterns of DES use were examined among non–ST-elevation myocardial infarction patients in the Can Rapid risk stratification of Unstable angina patients Supress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE; January 2006 to December 2006) and Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines (ACTION–GWTG; January 2007 to June 2008) registries to determine how practice patterns changed for patients with acute myocardial infarction undergoing PCI. Among the 54 662 patients analyzed, the percentage of patients undergoing PCI by quarter varied from 54% to 58% during the analysis time period. More than 90% of patients undergoing PCI received a DES in the first 3 quarters of 2006 before the public debate about the risks of DES began. Thereafter, the use of DES for PCI patients declined during the fourth quarter of 2006 through the first quarter of 2007 (82% to 67%), gradually declined during quarters 2 to 4 of 2007 (63% to 63% to 59%) but then slightly increased from the first to second quarter of 2008 (58% to 60%). Hospital characteristics did not seem to correlate with temporal changes in DES use, but by the last 2 quarters of the study period, patient characteristics such as white race, hypertension, diabetes mellitus, and private or managed care insurance were more common among patients who received a DES compared with the beginning 2 quarters of the study period.

Conclusions— These findings highlight how rapidly treatment decisions in contemporary practice can be affected by public debate related to scientific presentations and publications.

Key Words: stents • myocardial infarction • physician’s practice patterns

Guest Editor for this article was Brahmajee K. Nallamothu, MD.

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