Abstract 11057: Treatment Decisions for Coronary Artery Disease After Cardiac Catheterization
Introduction: Treatment for CAD can be divided into 3 strategies: medical therapy (MT), PCI, and CABG. Previous research has focused on outcomes for these strategies; however, studies have not examined the factors driving these decisions, or how these decisions have changed over time.
Methods: Using institutional data, we evaluated 22,537 patients undergoing catheterization from 1986 to 2012 who had significant CAD (≥1 coronary artery with ≥75% stenosis). Logistic regression models examined the association of patient baseline characteristics with the decision for revascularization vs. MT and for CABG vs. PCI. Models were developed in 3 different eras (Balloon angioplasty, 1986-1995; BMS, 1996-2003; DES, 2004-2012). In addition, we developed a combined model using all 3 eras to evaluate changes in decision making over time.
Results: During the study interval, the percent of patients having PCI increased dramatically, while CABG and MT rates fell (Figure 1). Significant factors influencing the decision to revascularize included STEMI, CAD severity, LV EF, and age. Increasingly complex CAD favored CABG over PCI, but this relationship has not changed over the study interval. Comorbidities, including diabetes and decreasing LV EF, appeared to have little influence on this decision (Figure 2).
Conclusion: Cardiac factors appear to dominate decisions about revascularization. Trends in treatment may be partly due to increased use of primary PCI for STEMI. Despite evidence of the benefits of CAGB in cohorts with DM and CHF, these factors appear to have had little influence on decision making regarding the method of revascularization.
- Coronary artery disease
- Percutaneous coronary intervention
- Cardiovascular therapeutics
- Heart catheterization
- © 2013 by American Heart Association, Inc.