Abstract
Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited. To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States. This retrospective cohort study used a national inpatient claims-based database to identify patients undergoing PCI or CABG from January 1, 2003, to December 31, 2016. Data analysis was performed from July 15 to October 4, 2019. Demographic characteristics, prevalence of risk factors, and clinical presentation divided into 3 eras (2003-2007, 2008-2012, and 2013-2016) and in-hospital mortality of PCI and CABG stratified by clinical indication. A total of 12 062 081 revascularization hospitalizations were identified: 8 687 338 PCIs (72.0%; mean [SD] patient age, 66.0 [10.8] years; 66.2% male) and 3 374 743 CABGs (28.0%; mean [SD] patient age, 64.5 [12.4] years; 72.1% male). The annual PCI volume decreased from 366 to 180 per 100 000 US adults and the annual CABG volume from 159 to 82 per 100 000 US adults. A temporal increase in the proportions of older, male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors was found in both groups. The percentage of revascularization for myocardial infarction (MI) increased in the PCI group (22.8% to 53.1%) and in the CABG group (19.5% to 28.2%). Risk-adjusted mortality increased slightly after PCI for ST-segment elevation MI (4.9% to 5.3%; P < .001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P < .001 for trend) but remained stable after PCI for non-ST-segment elevation MI (1.6% to 1.6%; P = .18 for trend). Risk-adjusted CABG morality markedly decreased in patients with MI (5.6% to 3.4% for all CABG and 4.8% to 3.0% for isolated CABG) and in those without MI (2.8% to 1.7% for all CABG and 2.1% to 1.2% for isolated CABG) (P < .001 for all). Significant changes were found in the characteristics of patients undergoing PCI and CABG in the United States between 2003 and 2016. Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications.
Highlights
Coronary artery revascularization has affected millions of patients with coronary artery disease (CAD) worldwide
Risk-adjusted mortality increased slightly after percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (MI) (4.9% to 5.3%; P < .001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P < .001 for trend) but remained stable after PCI for non–STsegment elevation MI (1.6% to 1.6%; P = .18 for trend)
Significant changes were found in the characteristics of hospital inpatients undergoing PCI and coronary artery bypass grafting (CABG) in the United States between 2003 and 2016
Summary
Coronary artery revascularization has affected millions of patients with coronary artery disease (CAD) worldwide. The annual volumes of both PCI and CABG decreased significantly in more recent years possibly because of advances in medical therapy, the emergence of data questioning the benefit of PCI in stable CAD, and the increasing implementation of appropriate use criteria.[8,9,10,11] Whether these temporal changes in procedural volume were associated with changes in the risk profiles of patients referred for percutaneous or surgical coronary revascularization and the outcomes of these procedures remain unknown. This study used a nationwide, representative sample hospital inpatients in the United States to assess the temporal changes in baseline characteristics of patients undergoing PCI or CABG and crude and risk-adjusted in-hospital mortality after PCI or CABG stratified by clinical indication
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