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Changes in the Practice of Coronary Revascularization between 2006 and 2010 in the Republic of Korea
Yoon Jung Choi1, Jin-Bae Kim2, Su-Jin Cho1
1Health Technology Assessment Team, Health Insurance Review and Assessment Service, Seoul, Korea.
Insights
Coronary revascularization increased in Korea from 2006-2010, with more percutaneous coronary intervention (PCI) and fewer coronary artery bypass graft (CABG) surgeries. In-hospital mortality rose for PCI but fell for CABG.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Economics
Background:
- Technological advancements and National Health Insurance Service reimbursement schemes may influence coronary artery disease management.
- Understanding shifts in coronary revascularization practices is crucial for healthcare policy and patient outcomes.
Purpose of the Study:
- To investigate changes in the practice patterns of coronary revascularization in Korea.
- To analyze trends in percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery rates.
- To examine in-hospital mortality associated with these procedures.
Main Methods:
- Analysis of medical claims data for Korean patients aged 20 and above from 2006 to 2010.
- Calculation of age- and sex-standardized coronary revascularization rates per 100,000 person-years.
- Comparison of procedure rates, stent utilization, and in-hospital mortality between PCI and CABG.
Main Results:
- Coronary revascularization rates increased from 116.1 to 131.0 per 100,000 person-years between 2006 and 2010.
- Percutaneous coronary intervention (PCI) rates increased by 16%, while coronary artery bypass graft (CABG) surgery rates decreased by 20%.
- Drug-eluting stent use in PCI rose from 89.1% to 93.0%; in-hospital mortality increased for PCI (p=0.03) but decreased for CABG (p=0.01).
- Higher in-hospital mortality was observed in elderly and female patients, and at lower-volume hospitals for both PCI and CABG.
Conclusions:
- Coronary revascularization volume in Korea showed a continuous annual increase from 2006 to 2010, with procedural trends varying by type.
- A high proportion of drug-eluting stent use in PCI procedures was observed.
- Higher in-hospital mortality rates at low-volume hospitals highlight potential quality disparities in care.
Purpose:
Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization.
Materials And Methods:
Revascularization and in-hospital mortality among Koreans ≥20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100,000 person-years was calculated directly from the distribution of the 2008 Korean population.
Results:
The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals.
Conclusion:
The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.
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