Trends in Coronary Revascularization in the United States From 2001 to 2009

Abstract

Background There is speculation that the volume of percutaneous coronary interventions (PCIs) has been decreasing over the past several years. Published studies of PCI volume have evaluated regional or hospital trends, but few have captured national data. This study describes the use of coronary angiography and revascularization methods in Medicare patients from 2001 to 2009. Methods and Results This retrospective study used data from the Centers for Medicare & Medicaid Services from 2001 to 2009. The annual number of coronary angiograms, PCI, intravascular ultrasound, fractional flow reserve, and coronary artery bypass graft (CABG) surgery procedures were determined from billing data and adjusted for the number of Medicare recipients. From 2001 to 2009, the average year-to-year increase for PCI was 1.3% per 1000 beneficiaries, whereas the mean annual decrease for CABG surgery was 5%. However, the increase in PCI volume occurred primarily from 2001 to 2004, as there was a mean annual rate of decline of 2.5% from 2004 to 2009; similar trends were seen with diagnostic angiography. The use of intravascular ultrasound and fractional flow reserve steadily increased over time. Conclusions This study confirms recent speculation that PCI volume has begun to decrease. Although rates of CABG have waned for several decades, all forms of coronary revascularization have been declining since 2004.

Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

“…However, the overall rate of PCI has declined over the last decade, because PCI now tends to be reserved for patients with more complex conditions. 2 Whereas mortality rates after emergency CABG from all causes are reported to be between 7% and 12%, 5,6,11,12 mortality rates in emergency CABG after attempted PCI are as high as 14%. 17 These data are crucial in eventually improving outcomes for these patients.…”

“…Historically, this was achieved with coronary artery bypass grafting (CABG); however, the advent of percutaneous coronary intervention (PCI) over 30 years ago brought about an increase in PCI and a decrease in CABG during those decades by 5% per year. 2 Today, more than 395,000 CABG procedures are performed annually in the United States. 3 A small proportion of these procedures are performed in emergency situations, most often because of ongoing ischemia, angiographic accidents, multivessel disease, or anatomic unsuitability for PCI.…”

Treatment of Higher-Risk Patients With an Indication for Revascularization

“…[11][12][13] Several factors have been identified as contributing to this decline. More effective implementation of GDMT after the publication of randomized trials examining the role of revascularization strategies for patients with stable CAD, 14,15 more judicious CAD screening protocols, and concerns about inappropriate percutaneous coronary intervention (PCI) have likely resulted in more selective use of diagnostic and revascularization procedures.…”

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

“…Повторная реваскуляризация у пациента, кото-рому было проведено КШ, представляет клиниче-скую сложность [506][507][508]. При определении пред-ний после КШ, но, поскольку число женщин, вклю-чаемых в такие исследования, небольшое, эти резуль-таты не свидетельствуют о половых различиях по исходам [496,497].…”