Related Experiment Video
Updated: Jan 30, 2026
Novel Percutaneous Approach for Deployment of 3D Printed Coronary Stenosis Implants in Swine Models of Ischemic Heart Disease
Published on: February 18, 2020
Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease
Andrew Czarnecki1, Feng Qiu2, Gabby Elbaz-Greener3
1Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Revascularization rates vary widely for stable ischemic heart disease patients, but this treatment improves outcomes like death and myocardial infarction, regardless of hospital practice patterns.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Outcomes
Background:
- Management of asymptomatic patients with stable ischemic heart disease and obstructive coronary artery disease is debated.
- This controversy may lead to significant variations in clinical practice.
Purpose of the Study:
- To assess practice variation in revascularization for asymptomatic stable ischemic heart disease patients.
- To identify predictors of this variation.
- To determine if revascularization variation impacts clinical outcomes.
Main Methods:
- Retrospective observational cohort study using population-based data from Ontario, Canada.
- Analysis of 9,897 patients with stable ischemic heart disease and obstructive coronary artery disease, comparing revascularization vs. medical therapy.
- Hierarchical logistic regression and proportional hazards models were used to assess predictors and outcomes.
Main Results:
- A 2-fold variation in revascularization rates was observed between hospitals.
- This variation was not explained by patient, physician, or hospital factors.
- Revascularization was associated with reduced hazards for death (HR 0.81) and myocardial infarction (HR 0.58).
Conclusions:
- Significant, unexplained variation exists in revascularization practices for stable ischemic heart disease.
- Revascularization demonstrates consistent clinical benefits across different practice settings.
Objectives:
The aims of this study were to assess variation in revascularization of asymptomatic patients with stable ischemic heart disease, identify the predictors of variation, and determine if it was associated with clinical outcomes.
Background:
Management of stable ischemic heart disease in asymptomatic patients with obstructive coronary artery disease is controversial, potentially leading to practice variation.
Methods:
A retrospective observational cohort study was performed using population-based data from Ontario, Canada, in patients with asymptomatic stable ischemic heart disease and obstructive coronary artery disease. The cohort was divided on the basis of treatment strategy: revascularization or medical therapy. Hospitals were allocated into tertiles of their revascularization ratio. Outcomes included death and nonfatal myocardial infarction. Hierarchical logistic regression was used to assess the predictors of revascularization, with median odds ratios used to quantify variation. Proportional hazards models were used to determine the association between management strategy and outcomes.
Results:
The cohort included 9,897 patients, 47% treated with medical therapy and 53% with revascularization. Between hospitals, 2-fold variation existed in the ratio of revascularized to medically treated patients. However, the variation across hospitals was not explained by patient, physician, or hospital factors (median odds ratio in null model: 1.25; median odds ratio in full model: 1.31). Revascularization was associated with a hazard ratio of 0.81 (95% confidence interval: 0.69 to 0.96) for death and a hazard ratio of 0.58 (95% confidence interval: 0.46 to 0.73) for myocardial infarction, with this benefit consistent across tertiles of revascularization ratio.
Conclusions:
Wide variation was observed in revascularization practice that was not explained by known factors. Despite this variation, a clinical benefit was observed with revascularization that was consistent across hospitals.
More Related Videos
05:06Model of Ischemic Heart Disease and Video-Based Comparison of Cardiomyocyte Contraction Using hiPSC-Derived Cardiomyocytes
Published on: May 5, 2020
10:21Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test
Published on: September 22, 2023
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
02:53Conservative Site-specific Recombination and Phase Variation
The recognition sites for Cre recombinase called LoxP...
01:14What is Variation?
The range, standard deviation, standard error, and variance are the different measures of variation.
Range: The range is the difference between its maximum and...
01:23Rheumatic Heart Disease I: Introduction
01:19Variation
When independent and dependent variables are plotted on a scatter plot, the slope of a line is a value that describes the rate of change between the two...
01:21Rheumatic Heart Disease III: Medical Management