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

Abstract

IMPORTANCE Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited. OBJECTIVE To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States.

Applicability and Eligibility of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) for Patients who Underwent Revascularization with Percutaneous Coronary Intervention

“…For the present analysis, we excluded those who did not undergo stress testing prior to PCI and those who did not meet the study inclusion criteria ( Figure 1 ). he definition of moderate-to-severe ischemia in our registry was consistent with that of the ISCHMIA trial (details in Supplemental Table S1 ) [ 5 ].…”

“…The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) is a recently published randomized controlled trial (RCT) that compared the conservative strategy of using optimal medical therapy (OMT) and the invasive strategy that added revascularization to OMT in patients with SIHD who had moderate-to-severe ischemia. The trial demonstrated no significant differences in the rate of all-cause death or myocardial infarction (MI) between the two strategies [ 5 ]. The clinical implication of the ISCHEMIA trial was that the SIHD patients who fulfilled the eligibility criteria and matched the profile of those in the ISCHEMIA trial can be initially treated with a conservative strategy [ 6 ].…”

Left ventricular unloading in ST‐elevation myocardial infarction without cardiogenic shock

“…Nonetheless, in-hospital mortality among STEMI patients undergoing PCI, infarct size, and the incidence of post-MI heart failure (HF) remained virtually unchanged. [2][3][4][5][6] In one study of 7733 elderly patients with acute myocardial infarction (AMI), 76% of those who survived the AMI hospitalization developed HF in the next 5 years. 7 Hence, the need for novel approaches to improve STEMI outcomes was increasingly emphasized.…”

Stabile koronare Herzkrankheit – die Attraktivität der Bypassoperation

“…Anhaltspunkte dafür sind darin zu sehen, dass Deutschland hinsichtlich des Verhältnisses von PCI zu Bypassoperationen von deutlich über 10 weltführend ist [17] und aber nur 40-45 Bypassoperationen pro 100 000 Einwohner [18] vorgenommen werden. Dies ist deutlich weniger als die momentan 80-90 Bypassoperationen pro 100 000 Einwohner in den USA [19] und das, obwohl es in den USA in den letzten Jahren zu einem deutlichen Rückgang dieses Operationskonzeptes gekommen ist und der Zugang zu Bypassoperationen im amerikanischen Gesundheitssystem sicherlich deutlich eingeschränkter ist als im deutschen Gesundheitssystem. Umgekehrt verhält es sich mit den PCI-Revaskularisationen.…”