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Assessing the Nationwide Impact of a Registry-Based Randomized Clinical Trial on Cardiovascular Practice

Buccheri, Sergio; Sarno, Giovanna; Fröbert, Ole; Gudnason, Thorarinn; Lagerqvist, Bo; Lindholm, Daniel; Maeng, Michael; Olivecrona, Göran LU and James, Stefan (2019) In Circulation. Cardiovascular Interventions 12(3). p.007381-007381
Abstract

BACKGROUND: Registry-based randomized clinical trials have emerged as useful tools to provide evidence on the comparative efficacy and safety of different therapeutic strategies. However, it remains unknown whether the results of registry-based randomized clinical trials have a sizable impact on daily clinical practice. We sought, therefore, to describe the temporal trends in thrombus aspiration (TA) use in Sweden before, during, and after dissemination of the TASTE trial (Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia) results. METHODS AND RESULTS: From January 1, 2006, to December 31, 2017, we included all consecutive patients with ST-segment-elevation myocardial infarction undergoing percutaneous... (More)

BACKGROUND: Registry-based randomized clinical trials have emerged as useful tools to provide evidence on the comparative efficacy and safety of different therapeutic strategies. However, it remains unknown whether the results of registry-based randomized clinical trials have a sizable impact on daily clinical practice. We sought, therefore, to describe the temporal trends in thrombus aspiration (TA) use in Sweden before, during, and after dissemination of the TASTE trial (Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia) results. METHODS AND RESULTS: From January 1, 2006, to December 31, 2017, we included all consecutive patients with ST-segment-elevation myocardial infarction undergoing percutaneous revascularization in Sweden. All patients were registered in the Swedish Coronary Angiography and Angioplasty Registry. A total of 55 809 ST-segment-elevation myocardial infarction patients were included. TA use in Sweden substantially decreased after dissemination of TASTE results (from 39.8% to 11.8% during and after TASTE, respectively). Substantial variability in TA use across treating centers was observed before TASTE (TA use ranging from 0% to 70%), but after TASTE both the interhospital variability and the frequency of TA use were markedly reduced. A constant shift in medical practice was seen about 4 months after dissemination of the TASTE trial results. Time trends for all-cause mortality and definite stent thrombosis at 30 days were not associated with variations in TA use ( P values >0.05 using the Granger test). CONCLUSIONS: In Sweden, the results of the TASTE trial were impactful in daily clinical practice and led to a relevant decrease in TA use in ST-segment-elevation myocardial infarction patients undergoing percutaneous revascularization.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
clinical trial, mortality, myocardial infarction, registry, thrombosis
in
Circulation. Cardiovascular Interventions
volume
12
issue
3
pages
007381 - 007381
publisher
American Heart Association
external identifiers
  • scopus:85062595619
ISSN
1941-7632
DOI
10.1161/CIRCINTERVENTIONS.118.007381
language
English
LU publication?
no
id
c0048d24-1e5d-4865-9e1e-0f8c3926d758
date added to LUP
2019-03-20 09:44:28
date last changed
2019-04-10 04:22:00
@article{c0048d24-1e5d-4865-9e1e-0f8c3926d758,
  abstract     = {<p>BACKGROUND: Registry-based randomized clinical trials have emerged as useful tools to provide evidence on the comparative efficacy and safety of different therapeutic strategies. However, it remains unknown whether the results of registry-based randomized clinical trials have a sizable impact on daily clinical practice. We sought, therefore, to describe the temporal trends in thrombus aspiration (TA) use in Sweden before, during, and after dissemination of the TASTE trial (Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia) results. METHODS AND RESULTS: From January 1, 2006, to December 31, 2017, we included all consecutive patients with ST-segment-elevation myocardial infarction undergoing percutaneous revascularization in Sweden. All patients were registered in the Swedish Coronary Angiography and Angioplasty Registry. A total of 55 809 ST-segment-elevation myocardial infarction patients were included. TA use in Sweden substantially decreased after dissemination of TASTE results (from 39.8% to 11.8% during and after TASTE, respectively). Substantial variability in TA use across treating centers was observed before TASTE (TA use ranging from 0% to 70%), but after TASTE both the interhospital variability and the frequency of TA use were markedly reduced. A constant shift in medical practice was seen about 4 months after dissemination of the TASTE trial results. Time trends for all-cause mortality and definite stent thrombosis at 30 days were not associated with variations in TA use ( P values &gt;0.05 using the Granger test). CONCLUSIONS: In Sweden, the results of the TASTE trial were impactful in daily clinical practice and led to a relevant decrease in TA use in ST-segment-elevation myocardial infarction patients undergoing percutaneous revascularization.</p>},
  author       = {Buccheri, Sergio and Sarno, Giovanna and Fröbert, Ole and Gudnason, Thorarinn and Lagerqvist, Bo and Lindholm, Daniel and Maeng, Michael and Olivecrona, Göran and James, Stefan},
  issn         = {1941-7632},
  keyword      = {clinical trial,mortality,myocardial infarction,registry,thrombosis},
  language     = {eng},
  number       = {3},
  pages        = {007381--007381},
  publisher    = {American Heart Association},
  series       = {Circulation. Cardiovascular Interventions},
  title        = {Assessing the Nationwide Impact of a Registry-Based Randomized Clinical Trial on Cardiovascular Practice},
  url          = {http://dx.doi.org/10.1161/CIRCINTERVENTIONS.118.007381},
  volume       = {12},
  year         = {2019},
}