Trends in PCI volume after negative results from the COURAGE trial.
OBJECTIVE
To describe trends in the use of percutaneous coronary intervention (PCI) following the COURAGE trial, which found that medical therapy is as effective as PCI for patients with stable angina.


DATA SOURCES
We used the National Hospital Discharge Survey; inpatient and outpatient discharge data from Florida, Maryland, and New Jersey; and the English Hospital Episode Statistics database.


STUDY DESIGN
We report trends in PCI volume by diagnosis (stable angina vs. unstable angina or AMI) before and after publication of the COURAGE trial.


PRINCIPAL FINDINGS
The number of PCIs in patients without a diagnosis of AMI or unstable angina in Florida, Maryland, and New Jersey declined from 48,000 in 2006 to 40,000 in 2008 (-17 percent). There was no change in the number of PCIs in patients with a diagnosis of AMI. We observed similar patterns in U.S. community hospitals. PCI volume did not decline in England.


CONCLUSIONS
PCI volume declined after publication of the COURAGE trial. The experience of the COURAGE trial suggests that comparative effectiveness research can lead to cost-saving changes in medical practice patterns. However, there are many patients with stable coronary disease who continue to receive PCI post-COURAGE.
['Howard|David H|DH|', 'Shen|Yu-Chu|YC|']
D000787:Angina Pectoris D003657:Decision Making D004059:Diffusion of Innovation D004739:England D005431:Florida D006801:Humans D008396:Maryland D009515:New Jersey D062645:Percutaneous Coronary Intervention D010818:Practice Patterns, Physicians' D016032:Randomized Controlled Trials as Topic D014728:Veterans
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