Abstract 13980: Variation in the Management of Patients With Obstructive Coronary Disease: Insights From the VA CART Program
Background: Prior studies have shown variation in the use of percutaneous coronary intervention (PCI) relative to coronary artery bypass graft (CABG) surgery. However, these studies have not addressed variation in the use of revascularization as compared with medical therapy alone for obstructive coronary disease (CAD).
Methods: We evaluated all coronary angiograms performed in the VA between 2007 and 2010 using the VA CART Program. We identified patients with obstructive CAD by angiography, defined as > 50% left main stenosis or > 70% stenosis in any other major epicardial coronary. Patients were considered managed with revascularization if they received PCI or CABG within 30 days of angiographic demonstration of obstructive CAD. We calculated risk-adjusted facility-level rates of overall revascularization, PCI alone, and CABG alone.
Results: Among 77,984 patients with obstructive CAD at angiography, 40,338 patients (51.7%) received revascularization within 30 days. Hospital rates of revascularization for obstructive CAD varied considerably (median hospital proportion 50.4%; range 19.3% to 82.1%). By hospital quartile of revascularization rates, patient characteristics were similar for baseline demographics, cardiac and non-cardiac comorbidities, clinical presentation, and severity of coronary disease. Risk-adjusted facility rates of overall revascularization varied dramatically (range 22.5% to 81.8%). The majority of this variation was due to differences in risk-adjusted rates of PCI, with less variation in the risk-adjusted rates of CABG (Figure).
Conclusions: Within the VA, we observed significant facility-level variation in rates of revascularization for obstructive CAD. The majority of this variation was related to PCI rather than CABG. Further study is needed to determine if this variation is associated with patient outcomes and guide the effective and efficient use of revascularization.
- © 2013 by American Heart Association, Inc.