Percutaneous Transluminal Coronary Angioplasty in New York State

To the Editor. —Recently, twoJAMAarticles detailed the practice of percutaneous transluminal coronary angioplasty (PTCA) in New York State for the years 1990 (Hilborne et al¹) and 1991 (Hannan et al²). While Hilborne et al examined 1306 PTCAs at random, Hannan et al reviewed all 5827 procedures the following year. Hilborne et al followed procedural mortality, but in 1991, Hannan et al changed that end point to inhospital mortality. Such changes have made it difficult to detect trends in PTCA patterns in New York State from 1990 through 1991; however, analysis is still possible, and some conclusions prove to be disturbing. Most statistics (overall success rate, percentage of men, number of single-vessel PTCAs, postprocedure myocardial infarctions, and acute vessel occlusions) remained virtually unchanged from 1990 to 1991, while others varied only slightly (rate of emergency bypass and the percentage of patients aged 65 years and older). Mortality