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Coronary revascularization trends in the United States, 2001-2008

Andrew J Epstein1, Daniel Polsky, Feifei Yang

  • 1Department of Veterans Affairs' Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA.

JAMA
|May 5, 2011
PubMed

Insights

Coronary revascularization rates decreased significantly, with coronary artery bypass graft (CABG) surgery utilization declining while percutaneous coronary interventions (PCI) remained stable between 2001 and 2008 in US hospitals.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Interventional Cardiology

Background:

  • Coronary revascularization is a common U.S. hospital procedure.
  • The impact of new technologies, trial evidence, and guidelines on revascularization trends is unclear.

Purpose of the Study:

  • To analyze national trends in the rates and types of coronary revascularizations.
  • Examine changes in coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) utilization.

Main Methods:

  • Serial cross-sectional study of US hospitalizations from 2001-2008.
  • Utilized Healthcare Cost and Utilization Project's Nationwide Inpatient Sample and Medicare claims.
  • Analyzed annual procedure rates for CABG surgery and PCI.

Main Results:

  • Overall coronary revascularization rates decreased by 15% from 2001-2002 to 2007-2008.
  • Coronary artery bypass graft (CABG) surgery rates declined significantly, while percutaneous coronary intervention (PCI) rates remained stable.
  • The number of hospitals performing CABG surgery increased, but the median caseload per hospital decreased, with more hospitals performing fewer procedures.

Conclusions:

  • Coronary artery bypass graft (CABG) surgery utilization substantially decreased in US hospitals between 2001 and 2008.
  • Percutaneous coronary intervention (PCI) utilization rates remained unchanged during the same period.
  • Trends suggest a shift in revascularization strategies, with declining CABG surgery use despite increased PCI hospital availability.
Abstract

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