Declining use of percutaneous coronary intervention across population groups, 2011-2022

Area of Science:

• Cardiovascular medicine
• Health services research
• Public health

Background:

• Coronary revascularization rates have decreased due to fewer acute coronary syndromes (ACS) and updated appropriate use criteria (AUC).
• Population-based trends in utilization across sociodemographic groups remain understudied.

Purpose of the Study:

• To analyze temporal trends in cardiac catheterizations and percutaneous coronary interventions (PCI) in California from 2011 to 2022.
• To assess sociodemographic and facility-type disparities in PCI utilization.

Main Methods:

• Utilized the Health Care Access and Information database for annual cardiac catheterization and PCI data.
• Compared PCI shares of cardiac catheterizations across sociodemographic strata and facility types.
• Employed regression models for trend analysis and pairwise comparisons for stratum differences.

Main Results:

• Identified 1,839,444 cardiac catheterizations between 2011 and 2022.
• Observed initial decreases in catheterizations and PCI (2011-2013), followed by a plateau, and another decrease in 2020.
• Found higher PCI shares associated with higher income, private insurance, and White or Asian/Pacific Islander race compared to Black or Hispanic individuals.

Conclusions:

• California's PCI share declined, likely due to reduced ACS and revised AUC for coronary revascularization.
• The divergence in PCI versus overall catheterization trends suggests specific impacts on interventional procedures.
• Persistent sociodemographic and payer-based disparities in PCI share highlight utilization heterogeneity, even after Medicaid expansion.