Key result
Higher interventional cardiologist CABG referral rates are linked to ~92% less repeat revascularization with similar MACE.
Why the study?
Does a higher interventional cardiologist CABG referral rate reduce mortality, MACE, or repeat revascularization in patients undergoing angiography?
Observational (n=252,408)
Yes
Does a higher interventional cardiologist CABG referral rate reduce mortality, MACE, or repeat revascularization in patients undergoing angiography?
There is marked 13-fold inter-operator variation in CABG referral rates among interventional cardiologists; higher referral rates are associated with reduced repeat revascularization but no difference in survival or MACE.
Objective Quantify inter-operator variation in referred coronary artery bypass grafting (CABG) following angiography and evaluate associations with practice patterns and long-term outcomes. Methods Observational study using administrative health data in British Columbia, Canada (2010–2024). Interventional cardiologist level CABG Rate was defined as the proportion of referred CABGs to total angiograms performed. Variation across Interventionalists was correlated with other practice characteristics. Among patients undergoing angiography followed by revascularization, associations between operator CABG Rate and all-cause mortality, major adverse cardiovascular events (MACE), and repeat revascularization were evaluated using hierarchical Cox regression. Results Among 252,408 angiograms by 40 Interventionalists, CABG Rate varied 13-fold (2.03%–26.4%) and was not explained by hospital-level factors alone (ICC: 0.358; 95% CI: 0.054-0.621). Higher CABG Rates were associated with lower percutaneous coronary intervention (PCI) utilization (R=–0.60;P<.001), lower PCI extensiveness (R=–0.52;P<.001), and lower procedural volume (R=–0.36;P=.022). In 73,603 first-time revascularized patients, CABG Rate was associated with reduced repeat revascularization (HR = 0.075;P<.001), without differences in mortality or MACE. Conclusions Referred CABG varies markedly between Interventionalists and reflects operator practice style. Higher CABG utilization is associated with more durable revascularization without impact on survival or MACE. Broader implementation of multidisciplinary Heart Teams may improve consistency of care.
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Blackman et al. (2026) conducted an observational in Patients undergoing angiography (n=252,408). Higher operator CABG referral rate vs. Lower operator CABG referral rate was evaluated on Repeat revascularization (HR 0.075, p=<0.001). Higher interventional cardiologist CABG referral rates were associated with reduced repeat revascularization (HR 0.075; P<0.001), without differences in mortality or MACE.
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