Rates of Elective Percutaneous Coronary Intervention in England and Wales: Impact of COURAGE and ORBITA Trials

Rashid, Muhammad; Stevens, Chris; Wijeysundera, Harindra C.; Curzen, Nick; Wah Khoo, Chee; Osama Mohamed, Mohamed; Aktaa, Suleman; Wu, Jianhua; Ludman, Peter F.; Mamas, Mamas A.

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.

Citation

Rashid, M., Stevens, C., Wijeysundera, H. C., Curzen, N., Wah Khoo, C., Osama Mohamed, M., …Mamas, M. A. (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), Article e025426. https://doi.org/10.1161/jaha.122.025426

• Journal Article Type: Article
• Acceptance Date: Jul 26, 2022
• Online Publication Date: Sep 14, 2022
• Publication Date: Sep 20, 2022
• Publicly Available Date: May 30, 2023
• Journal: Journal of the American Heart Association
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 18
• Article Number: e025426
• DOI: https://doi.org/10.1161/jaha.122.025426
• Public URL: https://keele-repository.worktribe.com/output/426599
• Publisher URL: https://www.ahajournals.org/doi/10.1161/JAHA.122.025426