Abstract 15946: A Tale of Two States: Comparison of PCI Case Mix in New York and Michigan
Introduction: Lower observed mortality rates for percutaneous coronary intervention (PCI) in states with mandatory public reporting (MPR) raise concerns of exclusion of high-risk patients who may benefit from revascularization. An alternative to MPR is cross-institutional collaborative quality improvement (CQI). CQI provides peer-reviewed analysis and promotes accountability through sharing of information to institutions and providers but does not include practitioner-level public reporting.
Hypothesis: Centers participating in CQI will more likely include high-risk patients in their PCI case mix.
Methods: Using National Cardiovascular Data Registry (NCDR®) CathPCI Registry data from January 2011 through September 2012, we compared baseline patient and procedure characteristics of those who underwent PCI in New York, a state with MPR (N=51,983), to Michigan, a state with CQI (N=53,528). We then applied the CathPCI appropriate use criteria and mortality model to assess PCI appropriateness and the predicted risk of death in the two states. The model used generalized estimating equations to account for within-hospital clustering and adjusted for numerous covariates including age, gender, coronary artery disease, peripheral vascular disease, cardiogenic shock, NYHA class, renal failure, diabetes, lung disease and acute coronary syndrome.
Results: Patients receiving PCI in the CQI cohort had a greater burden of co-morbidities and severity of illness at time of PCI. The CQI cohort was more likely to undergo PCI for STEMI (13.9% vs 11.2%, p<0.0001), following cardiac arrest (1.8% vs 1.2%, p<0.0001), for cardiogenic shock (2.4% vs 1.6%, p<0.0001) or for proximal left anterior descending artery (15.6% vs 14.9%, p<0.0001) or left main artery (2.1% vs 1.7%, p 20%, were more likely to undergo PCI in the CQI state than in the MPR state (Figure 1). There was a higher rate of appropriate PCI in the CQI cohort (82.7% vs 81.5% (p<0.0001).
Conclusions: Patients who underwent PCI in a state with CQI were at higher risk than those in a state with MPR. Further research is warranted to determine if risk avoidance is responsible for the observed difference.
- © 2013 by American Heart Association, Inc.