Abstract 1589: Variation in the Choice of PCI vs CABG for Patients With Multivessel Coronary Disease in Northern New England
BACKGROUND: The many randomized trials of PCI versus CABG for patients with multivessel CAD have reported consistent results - comparable longterm survival, better early angina relief following CABG but at the cost of an increased up front risk for adverse events, higher rates of repeat revascularization with PCI. We wondered whether the wealth of published data had resulted in consistency across institutions in the utilization of these procedures.
METHODS: We examined data from our Northern New England Cardiovascular Disease Study Group PCI and CABG registries of consecutive procedures. The analysis was limited to the recent experience (1/07– 6/08) of 8 institutions supporting both forms of revascularization and non-emergent patients with 2 or 3 vessel diseases, no left main disease, undergoing their first revascularization. We report the percentage of eligible patients undergoing CABG vs PCI.
RESULTS: For patients with 2 or 3 VD, the mean CABG rate was 44%, ranging from a low of 22% to a high of 64%. Among the subset of patients with proximal LAD disease, the mean CABG rate increased to 54% but still ranged widely from 32% to 73%. Among the diabetic subset, the mean CABG rate was 51%, ranging from 33% to 63%. Finally, among the subset of patients with EF <40%, the mean CABG rate was 46% with the widest range of rates - 17% to 80%.
CONCLUSION: Despite consistent results from a large number of high quality randomized trials there is marked variability in the choice of revascularization procedure among the 8 hospitals in northern New England supporting both PCI and CABG. To what extent this reflects patient preference, physician preference, referral bias, or other characteristics of local care is unknown.