Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 50, Issue 13, Pages 1223-1229Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2007.06.022
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Funding
- NHLBI NIH HHS [R01 HL 59205, R01 HL 72435] Funding Source: Medline
- NIAMS NIH HHS [AR30582] Funding Source: Medline
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Objectives We sought to examine temporal trends in the utilization of coronary revascularization in a geographically defined population. Background Earlier reports on revascularization utilization focused on inpatient settings and did not distinguish incident from recurrent procedures. Furthermore, little is known on age- and gender-specific trends. Finally, longitudinal data on the utilization and results of coronary angiography as explanatory factors for the changing revascularization practice are lacking. Methods Data integrating diagnostic and therapeutic coronary procedures performed in Olmsted County (Minnesota) between 1990 and 2004 were analyzed. Standardized rates were calculated applying the direct method and temporal trends compared using Poisson regression models. Results Revascularization utilization increased by 24% during the study (95% confidence interval [Cl] 5% to 46%), but the trends diverged by procedure type, with a sustained increase (69%, 95% Cl 43% to 101%) for percutaneous coronary interventions (PCI) contrasting with a stabilization, then decline (-33%, 95% Cl -16% to -47%) for coronary artery bypass grafting (CABG). For PCI, although the use increased in all categories, greater increases were noted in the elderly, in women, and for recurrent procedures. No such patterns were detected for CABG. Angiography use remained stable, and the rate of 3-vessel and/or left main disease declined (-22%, 95% Cl -8% to -33%). Conclusions Over the 15-year period, revascularization increased in the community with a large increase in PCI partially offset by a decrease in CABG. More PCls are performed in women and the elderly and for recurrent disease. These changes occurred within the context of a decline in multivessel disease and thus likely reflect the natural history of coronary artery disease.
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