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Stability After Initial Decline in Coronary Revascularization Rates in the United States

Sajjad Raza1, Salil V Deo1, Ankur Kalra2

  • 1Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

The Annals of Thoracic Surgery
|May 1, 2019
PubMed

Insights

Coronary revascularization rates, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), declined in the U.S. before stabilizing. PCI rates consistently remained higher than CABG rates throughout the study period.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Uncertainty exists regarding the impact of revascularization advancements, new evidence, and guideline updates on annual coronary revascularization rates in the U.S.
  • The study addresses the evolving landscape of cardiac procedures in response to medical and scientific progress.

Purpose of the Study:

  • To analyze trends in annual coronary revascularization rates in the United States from 2005 to 2014.
  • To compare the rates of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) over the study period.
  • To examine demographic variations in revascularization rates.

Main Methods:

  • Utilized Nationwide Inpatient Sample data from 2005-2014 with appropriate weighting for national procedural volume assessment.
  • Estimated PCI with same-day discharge rates from available literature to accurately determine overall annual PCI rates.
  • Analyzed procedural volumes and trends for PCI and CABG across different demographic groups.

Main Results:

  • Annual PCI rates decreased from 353 to 277 per 100,000 adults between 2005 and 2009, then stabilized.
  • Annual CABG rates showed a steady decline from 120 to 93 per 100,000 adults during the same initial period, followed by stabilization.
  • PCI rates were consistently higher than CABG rates across all age groups and both sexes, with lower rates observed in women compared to men.

Conclusions:

  • Annual coronary revascularization rates have significantly changed, influenced by technique advancements, new evidence, and updated guidelines.
  • PCI rates exhibited a steeper decline than CABG rates before plateauing, maintaining a higher overall volume throughout the study.
  • Findings highlight distinct trends and sex-based disparities in the utilization of major coronary revascularization procedures.
Abstract

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