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- Title
Trends in Characteristics and Outcomes of Patients Undergoing Coronary Revascularization in the United States, 2003-2016.
- Authors
Alkhouli, Mohamad; Alqahtani, Fahad; Kalra, Ankur; Gafoor, Sameer; Alhajji, Mohamed; Alreshidan, Mohammed; Holmes, David R.; Lerman, Amir
- Abstract
This cohort study assesses the contemporary trends in the characteristics and outcomes of patients undergoing percutaneous coronary intervention and coronary bypass grafting. Key Points: Question: What are the contemporary trends in the characteristics and outcomes of patients undergoing coronary revascularization in the United States? Findings: In this cohort study of patients undergoing percutaneous coronary intervention and coronary bypass grafting in the United States from 2003 to 2016, risk-adjusted mortality temporally decreased significantly after coronary bypass grafting but not after percutaneous coronary intervention across all clinical indications. Meaning: This study revealed changes in the clinical profile of patients referred for coronary revascularization and in the temporal trends of risk-adjusted mortality of percutaneous coronary intervention and coronary bypass grafting in the United States from 2003 to 2016. Importance: Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited. Objective: To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States. Design, Setting, and Participants: This retrospective cohort study used a national inpatient claims-based database to identify patients undergoing PCI or CABG from January 1, 2003, to December 31, 2016. Data analysis was performed from July 15 to October 4, 2019. Main Outcomes and Measures: Demographic characteristics, prevalence of risk factors, and clinical presentation divided into 3 eras (2003-2007, 2008-2012, and 2013-2016) and in-hospital mortality of PCI and CABG stratified by clinical indication. Results: A total of 12 062 081 revascularization hospitalizations were identified: 8 687 338 PCIs (72.0%; mean [SD] patient age, 66.0 [10.8] years; 66.2% male) and 3 374 743 CABGs (28.0%; mean [SD] patient age, 64.5 [12.4] years; 72.1% male). The annual PCI volume decreased from 366 to 180 per 100 000 US adults and the annual CABG volume from 159 to 82 per 100 000 US adults. A temporal increase in the proportions of older, male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors was found in both groups. The percentage of revascularization for myocardial infarction (MI) increased in the PCI group (22.8% to 53.1%) and in the CABG group (19.5% to 28.2%). Risk-adjusted mortality increased slightly after PCI for ST-segment elevation MI (4.9% to 5.3%; P <.001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P <.001 for trend) but remained stable after PCI for non–ST-segment elevation MI (1.6% to 1.6%; P =.18 for trend). Risk-adjusted CABG morality markedly decreased in patients with MI (5.6% to 3.4% for all CABG and 4.8% to 3.0% for isolated CABG) and in those without MI (2.8% to 1.7% for all CABG and 2.1% to 1.2% for isolated CABG) (P <.001 for all). Conclusions and Relevance: Significant changes were found in the characteristics of patients undergoing PCI and CABG in the United States between 2003 and 2016. Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications.
- Subjects
UNITED States; AGE distribution; CARDIOVASCULAR diseases; CONFIDENCE intervals; CORONARY artery bypass; INCOME; MYOCARDIAL infarction; PATIENTS; SEX distribution; SURGERY; LOGISTIC regression analysis; TREATMENT effectiveness; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; HOSPITAL mortality; PERCUTANEOUS coronary intervention
- Publication
JAMA Network Open, 2020, Vol 3, Issue 2, pe1921326
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.21326