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Association Between Interventional Cardiologist Practice Characteristics, Coronary Artery Bypass Grafting Use, and
Justin Blackman1, Stephanie Quon2, Darrel P Francis3
1Island Medical Program, Faculty of Medicine, University of British Columbia, Victoria, BC V8P 5C2, Canada.
Summary
Interventional cardiologists show significant variation in referring patients for coronary artery bypass grafting (CABG). Higher CABG rates correlate with less repeat revascularization, without affecting survival or major adverse cardiovascular events (MACE).
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Interventional Cardiology
Background:
- Significant inter-operator variability exists in referral rates for coronary artery bypass grafting (CABG) after angiography.
- Understanding this variation is crucial for optimizing patient care and resource allocation in cardiovascular interventions.
Purpose of the Study:
- To quantify inter-operator variation in CABG referrals following angiography.
- To evaluate the association of this variation with practice patterns and long-term patient outcomes.
Main Methods:
- Observational study using Canadian administrative health data (2010-2024).
- Calculated CABG Rate per interventionalist (CABGs referred/total angiograms).
- Correlated CABG Rate with practice characteristics and analyzed long-term outcomes (mortality, MACE, repeat revascularization) using Cox regression.
Main Results:
- A 13-fold variation in CABG Rate (2.03%-26.4%) was observed among 40 interventionalists performing 252,408 angiograms.
- Higher CABG Rates were linked to lower percutaneous coronary intervention (PCI) utilization and procedural volume.
- In 73,603 revascularized patients, higher CABG Rate was associated with reduced repeat revascularization (HR=0.075) but no difference in mortality or MACE.
Conclusions:
- Referred CABG rates vary substantially between interventionalists, reflecting individual practice styles.
- Higher CABG utilization is associated with more durable revascularization without compromising survival or MACE.
- Implementing multidisciplinary Heart Teams could enhance care consistency.
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