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Myocardial Revascularization in New York State: Variations in the PCI-to-CABG Ratio and Their Implications.
MedLine Citation:
PMID:  23130131     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: During the past 2 decades, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among hospitals and regions.
METHODS AND RESULTS: We reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 through 2008 to define trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of the State. During this 15-year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries, and for PCI for New York State were -40%, -20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were similar as follows: -61%, -23%, +14%, and +284%. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; however, in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher than the ratios for New York City programs outside Manhattan, in Long Island, in the northern counties contiguous to New York City, and in the rest of New York State; their averages were 5.84, 5.38, 3.31, and 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared with the rest of New York State; in one Manhattan program, the likelihood was 215% higher.
CONCLUSIONS: There are substantial regional and statewide differences in the utilization of PCI versus CABG among cardiac centers in New York, possibly related to patient characteristics, physician biases, and hospital culture. Understanding these disparities may facilitate the selection of the most appropriate, effective, and evidence-based revascularization strategy. (J Am Heart Assoc. 2012;1:e001446 doi: 10.1161/JAHA.112.001446.).
Wilson Ko; Robert Tranbaugh; Jonathan D Marmur; Phyllis G Supino; Jeffrey S Borer
Publication Detail:
Type:  Journal Article     Date:  2012-04-24
Journal Detail:
Title:  Journal of the American Heart Association     Volume:  1     ISSN:  2047-9980     ISO Abbreviation:  J Am Heart Assoc     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-11-06     Completed Date:  2012-11-07     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101580524     Medline TA:  J Am Heart Assoc     Country:  England    
Other Details:
Languages:  eng     Pagination:  e001446     Citation Subset:  -    
Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY (W.K., R.T.) ; New York Medical College, Vahalla, NY (W.K.).
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