Fifteen-Year Trends in the Rates of Elective Percutaneous Coronary Intervention and Impact of COURAGE and ORBITA Trials: Insights From British Cardiovascular Intervention Society Dataset

Abstract

Background This study was designed to evaluate temporal trends in elective rates of percutaneous coronary intervention (PCI) for stable angina and, specifically, to study the impact of the COURAGE and ORBITA trials on real-life practice. Methods We analyzed a large, longitudinal PCI cohort containing more than 1.2 million patients undergoing PCI for stable angina between January 2006 and December 2019. Patient demographics, procedural details, and clinical outcome data were analyzed, and temporal trends in the proportion of PCI for stable angina were compared before and after the publication of COURAGE and ORBITA trials, respectively. Results Out of 1,297,919 PCI procedures, 430,248 (33.1%) were for stable angina. 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 51.1% in 2019) remained stable (Fig. 1). The proportion of patients undergoing elective PCI without angina almost doubled from 5.1% to 9.7%. The rates of PCI remained stable after the publication of the COURAGE trial (46.5% to 44.7%) and the ORBITA trial (35.3% to 35.1%). Subgroup analysis of ORBITA participating centers showed similar stable trends in clinical and procedural profiles before and after the publication of the ORBITA trial. Conclusion In this nationwide analysis, rates of elective PCI for stable angina have remained stable over a 15-year period in England and Wales. Publication of COURAGE and ORBITA trials had no impact on elective PCI activity or the clinical profile of patients undergoing PCI for stable angina.