Key result
The regional rate of percutaneous coronary intervention was positively associated with the number of hospital beds (coefficient 59.4) and negatively associated with the number of cardiothoracic surgeons (coefficient -65.5).
Why the study?
Korea has experienced a rapid increase in PCI with the world's highest PCI-to-CABG ratio, prompting examination of the factors associated with CABG and PCI rates.
Observational (n=71,538)
Effect estimate: Coefficient 59.406 (95% CI 37.910-80.902)
p-value: p=<0.001
The high rate of PCI relative to CABG in Korea appears to be driven by supply-side factors such as hospital bed availability and a lack of cardiothoracic surgeons, suggesting potential overuse of PCI and underuse of CABG.
May indicate supply-driven revascularization patterns; hypothesis-generating for prospective studies on surgeon distribution and outcomes.
BACKGROUND: Korea has seen a rapid increase in the use of percutaneous coronary intervention (PCI) with the ratio of PCI to coronary artery bypass graft (CABG) the highest in the world. This study was performed to examine the factors associated with the rates of CABG and PCI. METHODS: The data were acquired from the National Health Insurance database in Korea in 2013. We calculated the age-sex standardized rates of CABG and PCI. We examined the factors associated with the CABG and PCI rates by performing a regression analysis. RESULTS: The rate of CABG showed a negative association with the deprivation index score, and other factors, such as the number of providers or hospital beds, did not show any significant association with the CABG rate. The rate of PCI had a strong negative association with the number of cardiothoracic surgeons and a strong positive association with the number of hospital beds. CONCLUSIONS: The positive association between the PCI rate and the number of hospital beds suggests that the use of PCI may be driven by the supply of beds, and the inverse association between the PCI rate and the number of cardiothoracic surgeons indicates the overuse of PCI due to lack of the providers of CABG. Policy measures should be taken to optimize the use of revascularization procedures, the choice of which should primarily be based on the patient's need.
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Kim et al. (2019) conducted an observational in Coronary artery disease requiring revascularization (n=71,538). Regional supply of hospital beds and cardiothoracic surgeons was evaluated on Rate of percutaneous coronary intervention (PCI) per 100,000 persons (Coefficient 59.406, 95% CI 37.910-80.902, p=<0.001). The regional rate of percutaneous coronary intervention was positively associated with the number of hospital beds (coefficient 59.4) and negatively associated with the number of cardiothoracic surgeons (coefficient -65.5).
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