Key result
Treatment at high PCI:CABG ratio hospitals is linked to ~117% higher in-hospital CABG mortality.
Why the study?
With increasing PCI and declining CABG utilization in ACS, the study aimed to evaluate whether higher hospital PCI:CABG ratios lead to higher in-hospital mortality.
Does a higher hospital PCI:CABG ratio increase in-hospital mortality for ACS patients undergoing revascularization?
Observational (n=103,021)
Yes
Does a higher hospital PCI:CABG ratio increase in-hospital mortality for ACS patients undergoing revascularization?
Odds Ratio: 2.17 (95% CI 1.7–2.8)
Absolute Event Rate: 5.3% vs 2.5%
p-value: p=< 0.001
Higher hospital-level PCI:CABG ratios are associated with significantly increased in-hospital mortality for patients undergoing CABG for acute coronary syndromes, suggesting it may serve as a valid indicator of optimal case selection.
High PCI:CABG ratios were associated with higher CABG mortality; leaves open whether ratio reflects or drives case selection in ACS.
OBJECTIVE: The principal trend in acute coronary syndrome (ACS) is increasing utilization of percutaneous coronary interventions (PCI) and declining coronary artery bypass graft surgery (CABG) utilization. This study was designed to evaluate whether higher PCI:CABG ratios lead to higher in-hospital PCI or CABG mortality. METHODS: The National Readmission Database for years 2016 was queried for all hospitalized ACS patients who underwent coronary revascularization during their admission. The study population was derived from 355 US hospitals and included 103 021 patients. Hospitals were grouped based on their PCI:CABG ratio into low, intermediate, and high ratio quartiles with a median [interquartile ranges (IQR)] PCI:CABG ratio of 2.9 (2.5-3.2), 5.0 (4.3-5.9) and 8.9 (7.8-10.3), respectively multivariable logistic regression with adjustment for age, demographics and comorbidities were used to identify CABG:PCI ratio related risk for in-hospital CABG and PCI mortality. RESULTS: Higher PCI:CABG ratios correlated with an increased CABG mortality. There was a median (IQR) mortality of 2.5% (1.6-4.3) in the low ratio quartile; 3.1% (1.9-5.3) in the intermediate quartiles; and 5.3% (3.2-9.1) in the high ratio quartile (P < 0.001). On multivariate analysis, the PCI:CABG ratio was associated with an increased risk for CABG mortality with an adjusted odds ratio of 1.38 (95% CI, 1.14-1.67, P < 0.001) and 2.17 (95% CI, 1.70-2.80, P < 0.001) for hospitals with intermediate and high PCI:CABG ratios, respectively. There was no significant association between PCI:CABG ratio and PCI mortality. CONCLUSIONS: The programmatic PCI:CABG ratio is a valid indicator of optimal case selection. The PCI:CABG ratio correlates with in-hospital mortality in ACS.
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Klein et al. (2021) conducted an observational in Acute coronary syndrome (n=103,021). High PCI:CABG ratio vs. Low PCI:CABG ratio was evaluated on In-hospital CABG mortality (OR 2.17, 95% CI 1.70-2.80, p=< 0.001). Treatment at hospitals with a high PCI:CABG ratio was associated with increased in-hospital CABG mortality compared to low ratio hospitals (5.3% vs 2.5%; OR 2.17, 95% CI 1.70-2.80, P<0.001).
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