Public reporting and case selection for percutaneous coronary interventions: an analysis from two large multicenter percutaneous coronary intervention databases.
OBJECTIVE
The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI).


BACKGROUND
Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown.


METHODS
We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality.


RESULTS
Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4% vs. 8.7%, p < 0.0001) and cardiogenic shock (2.56% vs. 0.38%, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83% vs. 1.54%, p < 0.0001; odds ratio [OR] 0.54, 95% confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95% CI 0.84 to 1.31, p = 0.70, c-statistic 0.88).


CONCLUSIONS
There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.
Moscucci
Mauro
M
University of Michigan Health System, Ann Arbor, Michigan, USA. moscucci@umich.edu
Eagle
Kim A
KA
Share
David
D
Smith
Dean
D
De Franco
Anthony C
AC
O'Donnell
Michael
M
Kline-Rogers
Eva
E
Jani
Sandeep M
SM
Brown
David L
DL
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D030881:Disclosure / Q000706:statistics & numerical data; D006291:Health Policy; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008824:Michigan / Q000453:epidemiology; D015337:Multicenter Studies as Topic; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D020379:Risk Adjustment