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Regional differences in coronary revascularization procedures and outcomes : a nationwide 11-year observational study

Vaez, Marjan; Dalén, Magnus; Friberg, Örjan; Nilsson, Johan LU ; Frøbert, Ole; Lagerqvist, Bo and Ivert, Torbjörn (2017) In European heart journal. Quality of care & clinical outcomes 3(3). p.243-248
Abstract

Aims: The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.

Methods and results: We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients,... (More)

Aims: The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.

Methods and results: We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses.

Conclusion: There are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.

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author
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type
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publication status
published
subject
in
European heart journal. Quality of care & clinical outcomes
volume
3
issue
3
pages
6 pages
external identifiers
  • scopus:85032030587
ISSN
2058-1742
DOI
10.1093/ehjqcco/qcx007
language
English
LU publication?
yes
id
622e47c3-e162-4b9a-b083-49d622491a05
date added to LUP
2018-10-25 18:02:33
date last changed
2019-01-14 07:40:01
@article{622e47c3-e162-4b9a-b083-49d622491a05,
  abstract     = {<p>Aims: The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.</p><p>Methods and results: We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses.</p><p>Conclusion: There are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.</p>},
  author       = {Vaez, Marjan and Dalén, Magnus and Friberg, Örjan and Nilsson, Johan and Frøbert, Ole and Lagerqvist, Bo and Ivert, Torbjörn},
  issn         = {2058-1742},
  language     = {eng},
  month        = {07},
  number       = {3},
  pages        = {243--248},
  series       = {European heart journal. Quality of care & clinical outcomes},
  title        = {Regional differences in coronary revascularization procedures and outcomes : a nationwide 11-year observational study},
  url          = {http://dx.doi.org/10.1093/ehjqcco/qcx007},
  volume       = {3},
  year         = {2017},
}