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Comparing the use of coronary revascularization in France and the United States: Divergent trends

Michael K Gusmano1, Victor G Rodwin2, Daniel Weisz3

  • 1College of Health, Lehigh University, Bethlehem, PA 18015, United States.

Archives of Cardiovascular Diseases
|March 24, 2026
PubMed

Insights

Coronary revascularization use increased in France but decreased in the US between 2012-2018. These divergent trends in treating coronary artery disease (CAD) were primarily driven by percutaneous coronary intervention (PCI) and not explained by hospitalization rates.

Area of Science:

  • Cardiovascular Medicine
  • Health Services Research
  • Interventional Cardiology

Background:

  • Coronary revascularization is a primary treatment for coronary artery disease (CAD).
  • Recent trials indicate limited improvement in life expectancy with revascularization for stable CAD patients.
  • Understanding geographical trends in revascularization is crucial for optimizing patient care.

Purpose of the Study:

  • To compare temporal trends in coronary revascularization utilization between France and the United States from 2012 to 2018.
  • To investigate the drivers behind observed differences in revascularization rates in these two countries.

Main Methods:

  • Utilized administrative healthcare databases from France and the US.
  • Identified patients aged 35 years and older hospitalized for coronary artery disease (CAD) or congestive heart failure (CHF).
  • Analyzed the utilization of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) using ICD codes.
  • Conducted multivariate analyses to identify independent correlates of revascularization use.

Main Results:

  • Coronary revascularization significantly increased in France (13.3% overall, 24.6% in older adults) from 2012-2018.
  • Conversely, revascularization use decreased in the US (16.3% overall, 19.6% in older adults) during the same period.
  • Percutaneous coronary intervention (PCI) use largely mirrored these divergent trends.
  • These national differences were not solely attributable to changes in CAD/CHF hospitalization rates.
  • Age, comorbidities, sex, and income independently correlated with revascularization use in both nations.

Conclusions:

  • Significant divergence in coronary revascularization trends was observed between France and the US.
  • The observed trends could not be explained by hospitalization rates for CAD/CHF or patient-level correlates.
  • Further research is needed to understand the underlying healthcare system or policy factors driving these disparities.
Abstract

Keywords:
Coronary revascularizationFranceSexUnited States

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