Circulation, Vol 88, 2735-2743, Copyright © 1993 by American Heart Association
JL Ritchie, KA Phillips and HS Luft
BACKGROUND. This report describes the in-hospital experience with
percutaneous transluminal coronary angioplasty (PTCA) for the state of
California in 1989. Data are derived from the statewide hospital discharge
abstracts. METHODS AND RESULTS. A total of 24,883 PTCAs were performed;
most patients (70%) were men and most procedures were single vessel (87%).
About one fifth (19%) of patients had a principal diagnosis of acute
myocardial infarction (AMI). Overall mortality was 1.4% and was higher in
the AMI group (4.2%) versus the non-AMI group (0.8%, P = .0001). Mortality
was higher for AMI patients having PTCA on the day of or day after
admission (5.5%) versus those treated later (2.6%, P = .0001). Five percent
of patients had coronary artery bypass surgery (CABG) after PTCA; CABG was
performed on the same day as PTCA in 61.7% of cases. Patients presenting
with AMI were more likely to have CABG (7.1%) than non-AMI patients (4.5%,
P = .0001). Mortality associated with CABG was 7.3% and was higher in the
AMI group (12.0%) than in the non-AMI group (5.5%, P = .0001). Factors
predictive of increased mortality by bivariate analysis included age >
63 years (2.1% mortality versus 0.8% < or = 63, P = .01), female sex
(1.9% versus 1.2% for men, P < .01), and the presence of diabetes (1.9%
versus 1.3% for nondiabetics, P < .05). Multiple logistic regression
showed that timings of PTCA with respect to admission (P = .004) and age (P
= .05) were predictors of mortality, but female sex was predictive only in
the non-AMI group (P = .03). Mean hospital charges were $19,597 (+/- SD,
$18,213). Forty-two percent of the 110 hospitals performed more than the
recommended minimum of 200 cases per year. The requirement for CABG during
the same admission or the combined adverse outcome of CABG and/or death was
increased in the lower-volume centers for both AMI and non-AMI patients (P
< .001), although mortality alone was not. CONCLUSIONS. The mortality
and need for CABG surgery in the statewide California PTCA experience is
higher than that generally reported in the literature. In patients with an
admitting diagnosis of AMI, the overall mortality was higher, as was the
need for CABG and the associated CABG mortality. Most hospitals performed
fewer than 200 PTCAs per year. Rates of CABG surgery and the combination of
CABG and/or mortality, adjusted only for the presence or absence of AMI,
were increased at the low-volume institutions.
ARTICLES
Coronary angioplasty. Statewide experience in California
Institute for Health Policy Studies, University of California at San Francisco.
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