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Coronary Disease Surveillance in the Community: Angiography and Revascularization
Yariv Gerber1,2, Raymond J Gibbons3, Susan A Weston1
1Department of Health Sciences Research Mayo Clinic Rochester MN.
Insights
Coronary heart disease trends show initial declines but recent increases in angiography use and stable revascularization rates suggest the burden of coronary artery disease may no longer be decreasing.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Favorable trends in cardiovascular health indicators suggested a declining burden of coronary artery disease (CAD) until the early 2000s.
- Recent data indicate these positive trends may be reversing, necessitating an updated assessment of population-level CAD burden.
- Understanding these shifts is crucial for public health strategies and clinical practice.
Purpose of the Study:
- To evaluate the recent evolution of the population burden of coronary artery disease.
- To examine trends in coronary angiography and revascularization procedures within a community setting.
- To identify potential shifts in CAD prevalence and severity.
Main Methods:
- Analysis of age- and sex-adjusted trends in all coronary angiographic procedures and revascularizations in Olmsted County, MN (2000-2018).
- Inclusion of both invasive angiography and computed tomography angiography to assess overall diagnostic imaging utilization.
- Examination of revascularization rates, differentiating between percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries.
Main Results:
- Coronary angiography rates initially declined by 30% (2000-2009) but stabilized thereafter, with recent increases noted when including CT angiography.
- Prevalence and severity of coronary artery disease (CAD) on angiography declined from 2000 to 2009, followed by a plateau.
- Revascularization rates (PCI and CABG) decreased by 34% (2000-2009) and subsequently plateaued, with a slight recent increase.
Conclusions:
- Coronary angiography use in the community initially declined, then leveled off, and recently increased.
- Trends indicate a decrease followed by a plateau in CAD severity and revascularization rates.
- The recent stabilization and potential increase in utilization suggest the declining burden of coronary disease may be ending, highlighting the need for enhanced prevention and surveillance.
Abstract:
Background Temporal declines in cardiac stress tests results, coronary revascularization, and cardiovascular mortality have suggested a decline in the population burden of coronary disease until the 2000s. However, recent data indicate these favorable trends could be ending. We aimed to assess the evolution of the population burden of coronary disease in the community by examining trends in angiography and revascularization. Methods and Results We analyzed age- and sex-adjusted trends from all coronary angiographic diagnostic procedures and revascularizations performed in Olmsted County, MN from 2000 to 2018. A total of 12 981 invasive angiograms were performed among 9049 individuals (64% men; 55% aged ≥65 years). Adjusted angiography rates decreased by 30% (95% CI, 25%-34%) between 2000 and 2009 and leveled off thereafter. Including computed tomography, angiography uncovered an increase in angiography use in recent years (risk ratio=1.15 [95% CI, 1.07-1.23] for 2018 versus 2014) and a decline in the prevalence of anatomic CAD from 2000 to 2018. CAD severity declined substantially from 2000 to 2009, followed by a plateau. Among 6570 revascularizations (72% men; 57% aged ≥65 years), 77% were percutaneous coronary interventions and 23% coronary artery bypass graft surgeries. The adjusted revascularization rates declined by 34% (95% CI, 27%-39%) from 2000 to 2009, followed by a plateau (risk ratio=1.10 [95% CI, 1.00-1.22]). Conclusions Between 2000 and 2018 in the community, coronary angiography use declined initially, leveled off, and then increased. Trends in CAD severity and revascularization use decreased then plateaued. The most recent trends are concerning as they suggest the burden of coronary disease is no longer declining. This warrants reinvigorated primary prevention and population surveillance.
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