Adverse events after coronary revascularization procedures in California 2000 to 2010
Patrick D Rudersdorf1, Amir Abolhoda, Joseph S Carey
1Department of Surgery, Division of Cardiothoracic Surgery, University of California, Irvine, California.
Insights
Public reporting of coronary artery bypass grafting (CABG) mortality and the introduction of drug-eluting stents led to decreased adverse events. These changes in cardiac intervention practices resulted in over 6,000 fewer adverse events annually by 2010.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Public Health Policy
Background:
- Public reporting of coronary artery bypass grafting (CABG) mortality began in California in 2003.
- Drug-eluting stents (DES) were widely adopted in 2003, coinciding with public reporting initiatives.
- Adverse events following percutaneous coronary intervention (PCI) and CABG required analysis to assess the impact of these concurrent changes.
Purpose of the Study:
- To analyze adverse events after PCI and CABG in California.
- To evaluate the impact of public mortality reporting and drug-eluting stent introduction on cardiovascular intervention outcomes.
- To assess trends in mortality, readmission, and adverse events over a decade.
Main Methods:
- Utilized annual California hospital discharge data from 2000 to 2010.
- Determined in-hospital mortality and 1-year readmission rates for adverse events.
- Analyzed outcomes for isolated CABG, PCI for acute coronary syndrome (PCI-ACS), and other PCIs (PCI-noACS).
Main Results:
- CABG volume decreased by 58%; PCI volume decreased by 20% after their respective peaks.
- In-hospital and 1-year mortality for CABG decreased post-2003, while PCI mortality remained stable.
- Rates of acute myocardial infarction and stroke showed minimal variation; however, reintervention rates for PCI decreased significantly, and overall adverse cardiovascular and cerebral events at 1 year declined for all procedure types.
Conclusions:
- Coronary intervention volumes decreased in California during the study period.
- Adverse event rates declined following the implementation of public reporting and the use of drug-eluting stents.
- The combination of reduced procedure volume and improved outcomes led to a substantial annual reduction in adverse events, exceeding 6,000 by the end of the decade.
Abstract:
Public reporting of coronary artery bypass grafting (CABG) mortality in California was initiated in 2003. Drug-eluting stents were widely introduced in the same year. Adverse events after percutaneous coronary intervention (PCI) and CABG were analyzed to study the impact of these events. Annual California hospital discharge data were collected from 2000 through 2010. In-hospital mortality and hospital readmission for adverse events <1 year were determined for patients undergoing isolated CABG, PCI for acute coronary syndrome (PCI-ACS), and all other PCIs (PCI-noACS). CABG volume peaked in 2000 and subsequently decreased by 58%; PCI volume peaked in 2005 and subsequently decreased by 20%. After 2003, in-hospital mortality and 1-year mortality for CABG decreased whereas mortality after PCI remained unchanged. Event rates for acute myocardial infarction and stroke varied little over the decade; acute myocardial infarction at 1 year was 2.5% to 2.8% (CABG), 4.5% to 5.4% (PCI-ACS), and 4.6% to 5.8% (PCI-noACS); stroke rate was 1.4% to 1.7% (CABG), 1.2% to 1.6% (PCI-ACS), and 1.0% to 1.2% (PCI-noACS). Reintervention for PCI decreased markedly, from 18.8% to 12.8% (PCI-ACS) and 22.5% to 13.3% (PCI-noACS). Multiple adverse cardiovascular and cerebral events rate at 1 year decreased from 10.8% to 9.4% (CABG), 26.5% to 21.2% (PCI-ACS), and 26.8% to 18.4% (PCI-noACS). Excluding reinterventions, multiple adverse cardiovascular and cerebral events rate at 1 year was 8.3% (CABG), 14.6% (PCI-ACS), and 10.1% (PCI-noACS) in 2010. In conclusion, the volume of coronary interventions in California decreased whereas adverse event rates decreased after the introduction of public reporting and drug-eluting stents. Lower procedure volume combined with improved outcomes resulted in an annual decrease of >6,000 adverse events by the end of the decade.
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