Related Experiment Video
Updated: May 9, 2026
Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
Determinants of percutaneous coronary intervention vs coronary artery bypass grafting: an interprovincial comparison
Maral Ouzounian1, William Ghali, Alexandra M Yip
1Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Significant differences exist in how percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used across Canadian provinces. Patient factors influence choices, but other elements also play a role in revascularization decisions.
Area of Science:
- Cardiology
- Health Services Research
- Interventional Cardiology
Background:
- Utilization of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) shows significant variation.
- Understanding predictors of revascularization mode is crucial for standardized care.
Purpose of the Study:
- To investigate differences in predictors for PCI versus CABG across three Canadian provincial jurisdictions.
- To analyze trends and variations in revascularization strategies over time.
Main Methods:
- Retrospective analysis of patients undergoing PCI or isolated CABG in British Columbia, Alberta, and Nova Scotia (1996-2007).
- Calculation of age- and sex-standardized rates and PCI to CABG ratios.
- Logistic regression models used to identify independent predictors of revascularization choice.
Main Results:
- Over 32,000 CABG and 69,000 PCI procedures were performed.
- PCI to CABG ratios increased in all provinces, but varied significantly between them.
- Female sex and acute coronary syndrome favored PCI; older age, complex disease, and diabetes favored CABG.
Conclusions:
- Substantial interprovincial variability in PCI to CABG ratios exists.
- While patient factors predict revascularization choice, non-clinical factors also contribute significantly.
- Further research is needed to understand and address these disparities in cardiac care.
Background:
Marked variation exists concerning the utilization of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The objective of this study was to examine differences in predictors of mode of revascularization across 3 provincial jurisdictions.
Methods:
All patients who underwent PCI and isolated CABG in British Columbia, Alberta, and Nova Scotia between 1996 and 2007 were considered. Age- and sex-standardized rates of PCI and CABG per 100,000 population and PCI to CABG ratios were calculated by year and province. Logistic regression models were constructed to identify independent predictors of mode of revascularization in each province.
Results:
A total of 32,190 and 69,409 patients underwent CABG and PCI, respectively, during the study period. Significant increases in the age- and sex-adjusted PCI to CABG ratios were observed in all 3 provinces, but these ratios differed between provinces. Across all 3 jurisdictions, female sex and diagnosis of acute coronary syndrome favoured increased PCI vs CABG, and increased age, left main, or 3-vessel disease occurring before myocardial infarction, and diabetes favoured lower PCI vs CABG. After adjusting for clinical and angiographic factors, there remained a significant variation in choice of PCI vs CABG between the 3 provinces over time.
Conclusions:
Significant interprovincial variability in PCI to CABG ratios was observed. Though certain patient-related factors predictive of either PCI or CABG were identified, factors beyond clinical presentation played a role in the choice of revascularization approach.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care