Practice patterns and percutaneous coronary intervention outcomes: a comparison between Sweden and the US

Area of Science:

• Cardiology
• Health Services Research
• Comparative Effectiveness

Background:

• International comparisons of percutaneous coronary intervention (PCI) practice patterns and their impact on outcomes are limited.
• Understanding variations in PCI care between countries is crucial for improving patient management.

Purpose of the Study:

• To compare temporal PCI trends and outcomes between Sweden and a large US university hospital system.
• To assess the impact of differing practice patterns on patient mortality after PCI.

Main Methods:

• Utilized data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and the US National Cardiovascular Data Registry (NCDR) CathPCI Registry (2007-2021).
• Analyzed baseline characteristics, practice patterns, and all-cause mortality using random-effects Cox models for patients treated at university hospitals.
• Compared outcomes between 275,021 Swedish and 9,883 US patients, with mortality analysis on 108,136 Swedish and 9,592 US patients.

Main Results:

• Significant differences in patient demographics and comorbidities were observed between Sweden and the US.
• Sweden demonstrated lower rates of PCI for stable angina and reduced use of mechanical circulatory support.
• Despite variations in anticoagulation, stent use, and revascularization strategies, adjusted all-cause mortality at 1 year post-PCI was similar (HR 1.09; 95% CI 0.86-1.37).

Conclusions:

• No significant difference in adjusted 1-year post-PCI mortality was found between university hospitals in Sweden and the US.
• This suggests that despite diverse patient populations and practice variations, comparable outcomes can be achieved in PCI care.
• Findings highlight the robustness of PCI care delivery across different healthcare systems.