Abstract 15590: Myocardial Revascularization in New York State: Variations in the PCI to CABG Ratio
Percutaneous intervention (PCI) has increased dramatically compared to coronary artery bypass grafting (CABG) in the treatment of patients with coronary artery disease. However, the relative distribution of PCI and CABG appears to differ among hospitals and regions. We, thus, have reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 to 2008 to define the trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of New York State. During this 15 year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries and for PCI for New York State were -40%, -20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were -61%, -23%, +14% and +284%, respectively. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher (ANOVA, p-valve=0.006) than the ratios for the programs in New York City outside Manhattan, in Long Island, and in the northern counties contiguous to New York City, and the rest of upstate New York; their averages were 5.84, 5.38, 3.31, 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared to the rest of New York State; in one Manhattan program, the likelihood was 215% higher. There are clear and very significant differences in the utilization of PCI versus CABG for patients with coronary artery disease in the New York cardiac programs, possibly related to patient characteristics, physician biases and hospital culture. Understanding the basis of these disparities may allow us to draw useful inferences about the drivers of the changing deployment of these procedures, and may be useful in optimizing and setting a standard of care to facilitate evidence-based practices in regards to the distribution of these two revascularization strategies among patients with CAD.
- Aortocoronary bypass
- Percutaneous coronary intervention
- Coronary artery disease
- Myocardial revascularization
- Cardiac surgery
- © 2011 by American Heart Association, Inc.