Aims: There is a continuous increase in the number of percutaneous transluminal coronary angioplasty procedures performed per year per population in most industrialised countries. This analysis searches for trends in treatment decisions after diagnostic coronary angiography.
Methods and results: The degree of coronary artery disease and the therapeutic strategy were determined retrospectively in consecutive patients undergoing coronary angiography at a Swiss university hospital during three different time periods in the past 11 years (n = 750 in 1994, n = 500 in 1990, and n = 545 in 1983). The indication for coronary angioplasty rose from 45% in 1983 to 78% in 1990 and 87% in 1994 in patients with one-vessel disease, from 25% to 38% and 71% in patients with two-vessel disease, and from 10% to 24% and 29% in patients with three-vessel disease. In contrast, the use of conservative therapy declined with time, independent of the severity of coronary artery disease. Indications for coronary artery bypass grafting decreased in patients with two-vessel disease, but did not change in patients with three-vessel disease over the 11 year period.
Conclusions: The use of coronary angioplasty, bypass surgery, and conservative therapy changed drastically over the past decade, with an increasing use of angioplasty and a multivessel disease, and of bypass surgery in two-vessel disease. The expansion of coronary angioplasty is mainly related to increased use in patients previously treated conservatively.