What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease and valvular heart disease (n=1363642). Intervention: Cardiac surgery and percutaneous interventions vs. Temporal trends (2010 vs 2019). Primary outcome: Procedure volumes and risk-adjusted in-hospital mortality.

September 26, 2025BMC Cardiovascular Disorders1 citationsOpen Access

Trends in cardiac surgery and percutaneous interventions in New York: a statewide registry analysis (2010–2019)

RERaed M. EnnabYarmouk University

Key Result

Between 2010 and 2019, statewide PCI and CABG volumes remained stable, while TAVR volumes increased substantially from 3,703 to 9,963 cases with improving risk-adjusted mortality.

Study Design

Type

Observational (n=1,363,642)

Multicenter

Yes

Structured PICO

Population

1,363,642 cardiac procedures including percutaneous coronary interventions, coronary artery bypass grafting, and valve interventions performed in New York State non-Federal hospitals between 2010 and 2019.

Exposure

Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), surgical valve replacement/repair with or without CABG (Valve ± CABG), and transcatheter aortic valve replacement (TAVR)

Outcome

Procedure volumes and in-hospital mortality (observed, expected, and risk-adjusted)hard clinical

Statewide registry data from 2010-2019 demonstrate stable PCI and CABG volumes with low mortality, alongside a rapid expansion of TAVR and a concurrent decline in surgical valve procedures.

Limitations

Retrospective observational study relying on administrative registry data with potential coding errors and missing fields.
Public registry suppresses patient-level demographic and presentation fields such as age, sex, and detailed comorbidities.
Risk adjustment models lack contemporary metrics like SCAI shock stages or STS PROM for valve-in-valve procedures.
Follow-up was confined to in-hospital outcomes, lacking data on late complications or long-term survival.
Data is limited to a single U.S. state, which may restrict generalizability to lower-volume or rural settings.
Annual values for Valve/CABG and TAVR were estimated from overlapping 3-year windows, introducing modest estimation error.

Abstract

BACKGROUND: Contemporary practice in coronary and valve interventions continues to evolve with changing indications, technology, and systems of care. I characterized statewide procedure volumes and mortality for PCI, CABG, Valve ± CABG, and TAVR using a unified, internally consistent analytic framework. METHODS: I analyzed New York State public-use registry data (2010-2019). All PCI and Non-Emergency PCI are reported annually. Emergency PCI was derived annually at the hospital-year level as All PCI - Non-Emergency PCI; deaths and expected deaths were derived by subtraction and aggregated statewide. CABG is reported annually. Valve ± CABG and TAVR are provided as overlapping 3-year windows; I produced annualized values by averaging the per-year contribution from the two windows that include each year (single window at edges; TAVR available 2013-2019). Statewide Observed %, Expected %, O/E, and Risk-Adjusted % were computed as case-weighted aggregates. No hypothesis testing was performed. RESULTS: From 2010 to 2019, there were 1,005,980 PCI and 171,182 CABG procedures statewide. Overall PCI volume was stable (2010: 108,070; 2019: 108,552). Within PCI, Non-Emergency comprised 835,480 (83.1%) and Emergency 170,500 (16.9%); non-emergency PCI declined modestly (2010: 93,498 → 2019: 89,654), while emergency PCI increased (2010: 14,572 → 2019: 18,898). CABG volumes were broadly stable (2010: 18,842 → 2019: 17,876). Annualized Valve ± CABG volumes declined (≈ 14,822 in 2010 → 11,893 in 2019), whereas TAVR expanded after introduction (2013: 3,703 → 2019: 9,963). Pooled risk-adjusted mortality: All PCI 1.11%, Non-Emergency PCI 0.72%, Emergency PCI 3.07%, CABG 1.53%, Valve ± CABG 3.27% (2010-2019), and TAVR 2.93% (2013-2019). Across procedures and years, O/E ≈ 1.00, indicating good model calibration. CONCLUSIONS: Between 2010 and 2019, statewide PCI volume was stable; non-emergency PCI declined modestly, emergency PCI rose modestly, CABG volumes were broadly stable, Valve ± CABG decreased, and TAVR increased substantially with improving mortality. Overall PCI mortality remained low and largely stable, consistent with higher-risk case mix over time. These contemporary benchmarks can inform quality improvement, capacity planning, and policy while highlighting the need for continued monitoring of high-risk PCI pathways and long-term TAVR durability in younger patients.

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