Affordable Access

Publisher Website

Current status and outcomes of coronary revascularization 1999 to 2002: 148,396 surgical and percutaneous procedures

Authors
Journal
The Annals of Thoracic Surgery
0003-4975
Publisher
Elsevier
Publication Date
Volume
77
Issue
3
Identifiers
DOI: 10.1016/j.athoracsur.2003.06.019
Keywords
  • Original Article: Cardiovascular
Disciplines
  • Medicine

Abstract

Abstract Background Current practice, trends, and early outcomes in patients undergoing surgical and percutaneous coronary interventions (PCI) are changing and subject to speculation. Methods 148,396 consecutive patients in 69 HCA, Inc hospitals who underwent either PCI or coronary artery bypass grafting (CABG) were tracked in the HCA Casemix Database from 1999 through the first quarter of 2002. Comorbid conditions, procedures, complications, and outcome variables were defined through International Classification of Diseases, Ninth Revision coding. Odds ratios (OR) for death and other procedure-related complications were estimated using logistic regression adjusting for age, sex, and 31 other patient clinical and procedural characteristics. Results Now 65.4% of all coronary revascularization is by PCI with a 6.8% annual rate of increase whereas CABG volume is declining by 1.9% per year. However the majority of these changes occurred between 1999 and 2000 with only small changes in the last 3 years. Coronary artery bypass grafting is still utilized primarily for multivessel disease (3.38 bypasses per patient) whereas PCI is predominately (83%) still limited to single-vessel intervention. Unadjusted mortality rates over the full 13-quarter period were 1.25% for PCI and 2.63% for CABG ( p < 0.001), with PCI rates remaining constant and CABG mortality declining. Twenty-three percent of CABG is performed off pump with a lower mortality than conventional on-pump CABG (2.37% versus 2.69%, p < 0.001). Percutaneous coronary intervention patients have lower mortality (OR 0.51), and fewer acute renal failure (OR 0.39), neurologic (OR 0.12), and cardiac (OR 0.16) complications than CABG patients ( p < 0.001). Conclusions Interventions for coronary artery disease continue to rise primarily due to an increase in PCI. The volume of PCI continues to increase relative to CABG. Although adverse outcomes are higher after CABG, the proportion of multivessel disease treated is greater. The difference in adverse outcomes between CABG and PCI remains small and continues to decline.

There are no comments yet on this publication. Be the first to share your thoughts.

Statistics

Seen <100 times
0 Comments

More articles like this

Current status and outcomes of coronary revascular...

on The Annals of Thoracic Surgery March 2004

Influence of frailty and health status on outcomes...

on Circulation. Cardiovascular qu... September 2011

[Percutaneous transluminal coronary angioplasty an...

on Arquivos Brasileiros de Cardio... June 1995

Frequency of selected surgical procedures, Rhode I...

on Medicine and health, Rhode Isl... February 2004
More articles like this..