Coronary Revascularization Trends in the United States, 2001-2008

Department of Veterans Affairs' Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 05/2011; 305(17):1769-76. DOI: 10.1001/jama.2011.551
Source: PubMed


Coronary revascularization is among the most common hospital-based major interventional procedures performed in the United States. It is uncertain how new revascularization technologies, new clinical evidence from trials, and updated clinical guidelines have influenced the volume and distribution of coronary revascularizations over the past decade.
To examine national time trends in the rates and types of coronary revascularizations.
A serial cross-sectional study with time trends of patients undergoing coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCIs) between 2001 and 2008 at US hospitals in the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, which reports inpatient coronary revascularizations. These data were supplemented by Medicare outpatient hospital claims.
Annual procedure rates of coronary revascularizations, CABG surgery, and PCI.
A 15% decrease (P < .001) in the annual rate of coronary revascularizations was observed from 2001-2002 to 2007-2008. The annual CABG surgery rate decreased steadily from 1742 (95% confidence interval [CI], 1663-1825) CABG surgeries per million adults per year in 2001-2002 to 1081 (95% CI, 1032-1133) CABG surgeries per million adults per year in 2007-2008 (P < .001), but PCI rates did not significantly change (3827 [95% CI, 3578-4092] PCI per million adults per year in 2001-2002 vs 3667 [95% CI, 3429-3922] PCI per million adults per year in 2007-2008, P = .74). Between 2001 and 2008, the number of hospitals in the Nationwide Inpatient Sample providing CABG surgery increased by 12% (212 in 2001 vs 241 in 2008, P = .03), and the number of PCI hospitals increased by 26% (246 in 2001 vs 331 in 2008, P < .001). The median CABG surgery caseload per hospital decreased by 28% (median [interquartile range], 253 [161-458] in 2001 vs 183 [98-292] in 2008; P < .001) and the number of CABG surgery hospitals providing fewer than 100 CABG surgeries per year increased from 23 (11%) in 2001 to 62 (26%) in 2008 (P < .001).
In US hospitals between 2001 and 2008, a substantial decrease in CABG surgery utilization rates was observed, but PCI utilization rates remained unchanged.

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    • "Coronary revascularization has become one of the most common major medical interventions in the United States, with over 1 million procedures yearly[20]. Even so, revascularization is used less in both female and minority patients[21,22]. Local hospital capacity helps to explain the revascularization disparities between black and white AMI patients[23]. "

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    • "Vascular reconstruction remains a bottleneck clinical challenge for patients requiring coronary artery bypass, peripheral vascular surgery, or arteriovenous fistula. Over one million coronary revascularisation procedures are performed annually in the United States (Epstein et al., 2011). Despite their utility in the absence of autologous vessel replacements, conventional prosthetic vascular graft materials present a huge risk of thrombosis and infection (Zilla et al., 1994; Pektok et al., 2008). "
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    • "Coronary artery bypass grafting (CABG) remains the gold standard for the elective treatment of patients with complex and threevessel coronary artery disease [1]. Nonetheless, percutaneous coronary intervention (PCI) rates have increased over the past years, while CABG rates are declining despite better survival rates after CABG than after PCI in these patients [2] [3]. "
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