Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications
MONDAY, March 2, 2020 (HealthDay News) — Between 2003 and 2016, there were decreases in in-hospital mortality after coronary artery bypass grafting (CABG) but not after percutaneous coronary intervention (PCI), according to a study published online Feb. 14 in JAMA Network Open.
Mohamad Alkhouli, M.D., from the Mayo Clinic School of Medicine in Rochester, Minnesota, and colleagues used a national inpatient claims-based database to identify patients undergoing PCI (8,687,338 patients) or CABG (3,374,743 patients) to assess changes in risk profile and outcomes.
The researchers found annual decreases in PCI volume from 366 to 180 per 100,000 U.S. adults and CABG volume from 159 to 82 per 100,000 U.S. adults between 2003 and 2016. For both groups, over time, there was an increase in the proportions of older (≥85 years), male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors. In the PCI group, the percentage of revascularization for myocardial infarction (MI) increased (22.8 to 53.1 percent), as it did in the CABG group (19.5 to 28.2 percent). After PCI, risk-adjusted mortality increased slightly for ST-segment elevation MI and unstable angina or stable ischemic heart disease but remained stable after PCI for non-ST-segment elevation MI. For both all CABG and isolated CABG, risk-adjusted mortality markedly decreased in patients with MI and in those without MI.
“These data have important clinical implications for prerevascularization risk assessment by a multidisciplinary heart team regarding need for and choice of revascularization modality and optimization of postrevascularization medical therapies,” writes the author of an accompanying editorial.
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