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

Research output: Contribution to journalArticle

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, 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.

Details

Authors
  • Marjan Vaez
  • Magnus Dalén
  • Örjan Friberg
  • Johan Nilsson
  • Ole Frøbert
  • Bo Lagerqvist
  • Torbjörn Ivert
Organisations
External organisations
  • Karolinska Institutet
  • Örebro University Hospital
  • Skåne University Hospital
  • Uppsala University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Anesthesiology and Intensive Care
Original languageEnglish
Pages (from-to)243-248
Number of pages6
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume3
Issue number3
Publication statusPublished - 2017 Jul 1
Publication categoryResearch
Peer-reviewedYes