The numbers of coronary artery bypass graft surgeries dropped by one-third between 2001 and 2008 in the USA, researchers from the University of Pennsylvania reported in JAMA (Journal of the American Medical Association). However, the number of balloon angioplasties insertions of stents used to open up narrow blood vessels remained pretty much the same – these procedures are known as PCI (percutaneous coronary interventions).
The authors wrote:
“Coronary revascularization, comprising coronary artery bypass graft (CABG) surgery and PCI, is among the most common major medical procedures provided by the U.S. health care system, with more than 1 million procedures performed annually,” according to background information in the article.”
The researchers explained that new techniques for coronary revascularization, including DES (drug-eluting stents) and minimally CABG surgery have become increasingly more common over the last ten years – they tend to have better outcomes compared to old techniques and technologies.
The authors added:
“During this period of technological innovation, new published evidence, and updated guidelines, it is not well known whether or how the volume of coronary revascularization and its constituent types changed in the United States. Substantial changes in the overall volume of revascularizations or the relative use of CABG surgery vs. PCI would have important ramifications on clinical outcomes, health care costs, and the future organization and delivery of hospital-based cardiovascular care.”
Andrew J. Epstein, Ph.D., and team estimated patterns in the yearly totals for coronary revascularization procedures by gathering data from a representative national sample of hospitalization claims. They gathered data on individuals who underwent PCIs or CABG surgery between 2001 and 2008 in American hospitals in the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. They also added Medicare outpatient hospital claims data.
They found that from year 2001-2002 to 2007-2008 there was a 15% drop in the yearly totals for coronary revascularizations.
The number of CABG surgeries dropped by one third in the seven years up to the end of 2008, from 1,742 surgeries per million adults annually in 2001-2002 to 1,081 seven years later.
However, during the same period PCI rates dropped only slightly, from 3,827 PCIs per million annually in 2001-2002 to 3,667 per million seven years later.
The authors wrote:
“Between 2001 and 2008, the number of hospitals in the Nationwide Inpatient Sample providing CABG surgery increased by 12 percent, and the number of PCI hospitals increased by 26 percent. The median (midpoint) CABG surgery caseload per hospital decreased by 28 percent and the number of CABG surgery hospitals providing fewer than 100 CABG surgeries per year increased from 23 (11 percent) in 2001 to 62 (26 percent) in 2008.”
. Regarding their study findings, the authors wrote:
“(our findings) suggest the possibility that several thousand patients who underwent PCI in 2008 would have undergone CABG surgery had patterns of care not changed markedly between 2001 and 2008. Our data imply a sizeable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous, catheter-based interventions.
In conclusion, although the total rate of U.S. coronary revascularization decreased modestly between 2001 and 2008, there was a substantial decrease in the CABG surgery rate. Between 2001 and 2008, the rate of PCI did not significantly change; however, there were continual changes in the frequency of stent types used for PCI.”
Andrew J. Epstein, PhD; Daniel Polsky, PhD; Feifei Yang, MS; Lin Yang, MS; eter W. Groeneveld, MD, MS
JAMA. 2011;305(17):1769-1776. doi: 10.1001/jama.2011.551
Written by Christian Nordqvist