Stability After Initial Decline in Coronary Revascularization Rates in the United States

Abstract

Background. It remains uncertain how advances in revascularization techniques, availability of new evidence, and updated guidelines have influenced the annual rates of coronary revascularization in the United States.Methods. We used the Nationwide Inpatient Sample data from 2005 to 2014 with appropriate weighting to determine national procedural volumes. To present accurately overall percutaneous coronary intervention (PCI) rates, PCI with same-day discharge numbers per year were estimated from the available literature and added to annual PCI procedures performed.Results. Annual PCI rate declined from 353 per 100,000 adults in 2005 to 277 per 100,000 adults in 2009 (P < .001) but remained stable thereafter (P [ .50). Annual coronary artery bypass grafting (CABG) rate declined steadily, at a shallower slope than PCI, from 120 per 100,000 in 2005 to 93 per 100,000 in 2009 (P [ .02) but remained stable thereafter (P [ .60). Similar trends were seen in men and

Trends in Characteristics and Outcomes of Hospital Inpatients Undergoing Coronary Revascularization in the United States, 2003-2016

“…Several studies [4][5][6]9,11,14,23 have found a decrease in coronary revascularization procedures in the United States in the past 2 decades. However, most of these studies [4][5][6]9,11,14,23 were not contemporaneous, included only certain subsets of patients (eg, patients with Medicare insurance or AMI), or examined trends of surgical or percutaneous revascularization procedures. Although our primary objective was to assess the temporal changes among hospital inpatient risk profiles, procedural characteristics, and procedural mortality, the current study, to our knowledge, provides the most up-to-date nationwide analysis of the annual trends in coronary interventions conducted in hospitals.…”

“…However, the annual volumes of both PCI and CABG decreased significantly in more recent years possibly because of advances in medical therapy, the emergence of data questioning the benefit of PCI in stable CAD, and the increasing implementation of appropriate use criteria. [8][9][10][11] Whether these temporal changes in procedural volume were associated with changes in the risk profiles of patients referred for percutaneous or surgical coronary revascularization and the outcomes of these procedures remain unknown. This study used a nationwide, representative sample hospital inpatients in the United States to assess the temporal changes in baseline characteristics of patients undergoing PCI or CABG and crude and risk-adjusted in-hospital mortality after PCI or CABG stratified by clinical indication.…”

The impact of trainees' working hour regulations on outcome in CABG and valve surgery in the State of New York

“…18 A contraction in surgical revascularization volume is a natural consequence of the increase in percutaneous procedures, as already discussed elsewhere. 19,20 Valve surgery volume, in contrast, remained steady in NTH (−5.26%)…”

Coronary surgery in women: How can we improve outcomes

“…Patients who currently present for CABG have more comorbidities and a higher percentage have had percutaneous intervention than in prior years. 45 , 46 , 47 LaPar and colleagues 48 suggest that an expected isolated CABG mortality of less than 1% can be achieved in only 60% of patients. We propose that surgeon specialization in coronary surgery of women should be considered because surgeons are treating sicker patients while at the same time being faced with mandated transparency, intense scrutiny, and public reporting of outcomes.…”