Abstract 2019: Coronary Revascularization Strategy in British Columbia: Change in Ratio of PCI to CABG Between 2000 and 2007
Revascularization strategies for patients with CAD have varied widely and changed over time. We sought to evaluate the time trend of the PCI to CABG ratio in the province of British Columbia, Canada. The Cardiac Services BC Registry (CSBCR) prospectively collects data on patients having PCI or cardiac surgery. We calculated the PCI/CABG ratio for BC patients aged ≥20 years using CSBCR data for the years 2000 to 2007. The differences in time trends were investigated in a mixed-effects multiple logistic regression model by examining the interaction between year and various factors: age, sex, prior PCI/CABG, extent of CAD, indication for procedure, prior MI and diabetes. A positive estimate for an interaction indicates a faster rate of increase for PCI versus CABG. The PCI/CABG ratio increased from 2.28 in 2000 to 3.66 in 2007. The rate of increase was influenced by prior PCI/CABG, extent of CAD, indication for procedure and prior MI. The difference in the rate of increase (i.e. interaction estimate) is presented in the Table⇓; rates are faster for repeat versus first revascularization, 1- or 2-vessel versus 3-vessel/LM disease, ACS versus stable angina, and no prior MI versus prior MI. There was no difference in the rate of increase among age groups (20 –54, 55–74, 75+), between sex or non-diabetics versus diabetics, while the likelihood of receiving CABG was higher for the middle age group compared to younger (OR: 1.24, 95% CI: 1.17–1.32) or older group (1.48, 1.39 –1.56), for male compared to female (1.38, 1.30 –1.46) and for diabetics compared to non-diabetics (1.17, 1.12–1.24). The PCI/CABG ratio increased substantially between 2000 and 2007. The rate of increase differed among patient subgroups. The steepest increase is in patients with a prior revascularization suggesting an increased need for repeat PCI following first revascularization. The economic and clinical impacts of these changes are being actively researched.