Physicians' Academy for Cardiovascular Education

In-hospital mortality decreased after CABG, but not PCI from 2003 to 2016 in the US

Trends in Characteristics and Outcomes of Patients Undergoing Coronary Revascularization in the United States, 2003-2016

Literature - Alkhouli M, Alqahtani F, Kalra A et al., - JAMA Netw Open 2020. 3(2):e1921326, doi:10.1001/jamanetworkopen.2019.21326

Introduction and methods

The annual number of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) has decreased in recent years, possibly due to advances in medical therapy, the emergence of data questioning the benefit of PCI in stable CAD, and an increase in implementation of appropriate use criteria [1-4]. It remains unknown whether this change in procedural numbers is associated with changes in risk profiles of patients and with outcomes of the procedures.

This retrospective cohort study used the Nationwide Inpatient Sample (NIS) database to investigate temporal changes in baseline characteristics of patients undergoing PCI or CABG in the US from 2003 to 2016 and assessed in-hospital mortality after the procedures stratified by clinical indication. Data from 8,687,338 PCIs (72.0%, mean age 66.0 [SD=10.8] years, 66.2% was male) and 3,374,743 CABGs (28.0%, mean age was 64.5 [SD=12.4] years, 72.1% was male) were analyzed. PCIs were further classified into those performed for ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or unstable angina or stable ischemic heart disease (UA-SIHD). CABG procedures were classified into those performed in the context of acute myocardial infarction (AMI), or UA-SIHD. Clinical risk profile trends were investigated in 3 eras (2003-2007, 2008-2012, and 2012-2016).

Main results


The number of PCI and CABG procedures decreased in the US between 2003 and 2016. This was accompanied by changes in the demographic characteristics. In both groups, a temporal increase was observed in the proportion of male, elderly and nonwhite patients and patients with lower socioeconomic status. Changes in risk profile and clinical presentation of patients undergoing these procedures were also observed. Risk adjusted in-hospital mortality after PCI did not improve over time between 2003 and 2016, but decreased over time after CABG.


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