What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (CAD) (n=36298). Intervention: Medical and interventional treatment trends. Primary outcome: Trends in interventional procedures and medication.

What does this research mean for the field?

Medical and interventional treatments for Japanese coronary artery disease patients changed significantly over a 3.5-year period, with increased use of stents and angiotensin-receptor blockers, though short-term event rates remained unchanged. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 1, 2008Open Access

Demographics and Changes in Medical/Interventional Treatment of Coronary Artery Disease Patients Over a 3.5-Year Period in Japan The Japanese Coronary Artery Disease Study: Trend Examination

Key Result

Medical and interventional treatments for Japanese CAD patients changed significantly over 3.5 years, with increased stent and ARB use, though short-term event rates remained unchanged.

Study Design

Type

Observational (n=36,298)

Structured PICO

Population

36,298 consecutive patients who underwent coronary angiography and were diagnosed with ≥75% stenosis in at least 1 branch of a coronary artery, registered over 6 periods in Japan.

Outcome

Composite of all-cause death and cardiovascular events (fatal or nonfatal myocardial infarction, fatal or nonfatal strokes, other cardiovascular events, and death from any cause as the first event)composite

Over a 3.5-year period in Japan, significant changes in CAD management were observed, including increased use of stents and ARBs, reflecting rapid physician compliance with emerging clinical evidence.

Limitations

Observational study design
Background of patients in each cohort might have been heterogeneous

Abstract

BACKGROUND: Cardiovascular medicine has undergone rapid changes in recent years, but there are insufficient reports using large cohorts regarding these changes for Japanese coronary artery disease (CAD) patients. Hence, a large-scale prospective observational study was needed. METHODS AND RESULTS: A total of 36,298 patients were registered over 6 periods. Patients with hypertension, hyperlipidemia, obesity, and impaired glucose tolerance increased in number, while those with old myocardial infarction (MI), smoking habit, and family history of CAD decreased. Regarding the trends in interventional procedures, stent use increased in both the whole cohort and the acute MI subgroup, while the use of only medical control decreased. Regarding prescription trends, angiotensin-receptor blockers increased while nitrates decreased. CONCLUSIONS: In a period of 3.5 years, significant changes were observed for both interventional procedures and medication, which might be related to the well-timed compliance of physicians with published evidence. However, these changes were not related to changes in the event rates, at least over the short term. Although careful attention should be paid in interpreting the results, because this is an observational study and the background of patients in each cohort might have been heterogeneous, such investigations should be constantly conducted for evidence-based practice.

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