Massachusetts Study Sees Steep Declines in Revascularization Over Last Decade

WASHINGTON, DC—Over the last decade, steep declines have occurred in rates of coronary revascularization in Massachusetts, according to a study presented March 30, 2014, at the American College of Cardiology/i2 Scientific Session. Although the decrease was seen across all procedures, the largest absolute decline occurred in rates of percutaneous coronary intervention (PCI).

Robert W. Yeh MD, MSc, of Harvard Medical School (Boston, MA), and colleagues analyzed data for 154,461 procedures (76% PCI, 24% CABG) performed at non-VA hospitals in Massachusetts between April 2003 and September 2012.

After adjustment for age and sex, there was a 39% decline in the rate of total revascularizations over the study period, including a 37% decline in PCI and a 44% decline in CABG (table 1).

Table 1. Revascularization Rates Per 100,000 Massachusetts Residents

The elective PCI rate declined by 50%, from 200 to 101 per 100,000 Massachusetts residents over the study period. In contrast, PCI for MI saw only a 16% decline over the same period, from 117 to 98 per 100,000. 

Mortality Reductions for CABG

After adjustment for age, sex,cardiogenic  shock, and ejection fraction, among othe factors, the rate of crude 30-day mortality for all revascularizations fell from 2.4% to 1.9%. This was driven by a decline in CABG from 3.4% to 1.6%. Rates of 30-day mortality for PCI remained steady at 2.0% from the beginning to the end of the study.

Dr. Yeh noted that outcomes of patients who did not undergo revascularization were not reported, and neither were patient reported outcomes like angina and quality of life. Additionally, unmeasured factors that may account for declining risk-adjusted rates of 30-day mortality remain unknown. More importantly, the generalizability of the findings to areas outside of Massachusetts is unclear.

He hypothesized that from a positive standpoint, the declines may be due to improved quality of care and/or more careful patient selection. At the same time, he said the data also raise concern about the need for more oversight among centers performing cardiac catheterization.

Source:

Yeh RW. Steep declines in population rates of coronary revascularization. Presented at: American College of Cardiology/i2 Scientific Session; March 30, 2014; Washington, DC.

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