May 27, 2020Journal of the American Heart AssociationOpen Access

Temporal Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: Insights From the Washington Cardiac Care Outcomes Assessment Program

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Why the study?

How do temporal trends in clinical acuity and adjusted mortality compare between patients undergoing PCI versus CABG?

Structured PICO

How do temporal trends in clinical acuity and adjusted mortality compare between patients undergoing PCI versus CABG?

Population

Patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the Washington Cardiac Care Outcomes Assessment Program

Intervention

Percutaneous Coronary Intervention (PCI)

Comparator

Coronary Artery Bypass Grafting (CABG)

Outcome

Adjusted observed/expected mortality ratiohard clinical

The temporal increase in clinical acuity and adjusted mortality for PCI compared to CABG likely reflects a shift toward utilizing PCI in patients at high surgical risk.

Implication

May bias unadjusted PCI-CABG mortality comparisons; leaves open need for acuity-adjusted benchmarking in observational data.

Abstract

<0.0001) over the study period. Conclusions Clinical acuity increased for patients treated with PCI rather than CABG. This resulted in an increase in adjusted observed/expected mortality ratio for patients undergoing PCI and a decrease for CABG. These shifts may reflect an increased use of PCI instead of CABG for patients considered to be at high surgical risk.