Trends in Characteristics and Outcomes of Patients Undergoing Coronary Revascularization in the United States,
Mohamad Alkhouli1, Fahad Alqahtani2, Ankur Kalra3
1Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota.
Insights
Contemporary trends show increasing risk factors in patients undergoing percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG). While CABG mortality decreased, PCI mortality saw slight increases, highlighting evolving risk profiles and outcomes in cardiac revascularization.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Limited data exists on current risk profiles and outcomes for patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG).
- Understanding these trends is crucial for optimizing patient care and resource allocation in cardiovascular medicine.
Purpose of the Study:
- To analyze contemporary trends in patient characteristics and outcomes for PCI and CABG in the United States.
- To evaluate changes in risk factors, clinical presentation, and mortality rates over time for these revascularization procedures.
Main Methods:
- Retrospective cohort study utilizing a national inpatient claims database (2003-2016).
- Analysis of demographic characteristics, risk factors, clinical indications, and in-hospital mortality stratified by procedure (PCI vs. CABG) and era.
- Risk-adjusted mortality analysis performed across three distinct time periods.
Main Results:
- Over 12 million revascularization hospitalizations were identified, with PCI comprising 72% and CABG 28%.
- Annual volumes for both PCI and CABG decreased, while patient populations showed increases in age, male sex, non-white race, lower income, and prevalence of risk factors.
- Risk-adjusted mortality significantly decreased after CABG across all indications, but showed slight increases after PCI for specific conditions like STEMI and unstable angina.
Conclusions:
- Significant shifts in patient demographics and risk profiles were observed for both PCI and CABG between 2003 and 2016.
- Mortality following CABG improved significantly, whereas PCI outcomes showed mixed results with slight increases in mortality for certain indications.
- These findings underscore the need for continued monitoring and adaptation of treatment strategies in cardiac revascularization.
Importance:
Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited.
Objective:
To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States.
Design, Setting, And Participants:
This retrospective cohort study used a national inpatient claims-based database to identify patients undergoing PCI or CABG from January 1, 2003, to December 31, 2016. Data analysis was performed from July 15 to October 4, 2019.
Main Outcomes And Measures:
Demographic characteristics, prevalence of risk factors, and clinical presentation divided into 3 eras (2003-2007, 2008-2012, and 2013-2016) and in-hospital mortality of PCI and CABG stratified by clinical indication.
Results:
A total of 12 062 081 revascularization hospitalizations were identified: 8 687 338 PCIs (72.0%; mean [SD] patient age, 66.0 [10.8] years; 66.2% male) and 3 374 743 CABGs (28.0%; mean [SD] patient age, 64.5 [12.4] years; 72.1% male). The annual PCI volume decreased from 366 to 180 per 100 000 US adults and the annual CABG volume from 159 to 82 per 100 000 US adults. A temporal increase in the proportions of older, male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors was found in both groups. The percentage of revascularization for myocardial infarction (MI) increased in the PCI group (22.8% to 53.1%) and in the CABG group (19.5% to 28.2%). Risk-adjusted mortality increased slightly after PCI for ST-segment elevation MI (4.9% to 5.3%; P < .001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P < .001 for trend) but remained stable after PCI for non-ST-segment elevation MI (1.6% to 1.6%; P = .18 for trend). Risk-adjusted CABG morality markedly decreased in patients with MI (5.6% to 3.4% for all CABG and 4.8% to 3.0% for isolated CABG) and in those without MI (2.8% to 1.7% for all CABG and 2.1% to 1.2% for isolated CABG) (P < .001 for all).
Conclusions And Relevance:
Significant changes were found in the characteristics of patients undergoing PCI and CABG in the United States between 2003 and 2016. Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications.
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