Coronary revascularization in the community. A population-based study, 1990 to 2004.
OBJECTIVE
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 [CI] 5% to 46%), but the trends diverged by procedure type, with a sustained increase (69%, 95% CI 43% to 101%) for percutaneous coronary interventions (PCI) contrasting with a stabilization, then decline (-33%, 95% CI -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% CI -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 PCIs 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.
Gerber
Yariv
Y
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Rihal
Charanjit S
CS
Sundt
Thoralf M
TM
Killian
Jill M
JM
Weston
Susan A
SA
Therneau
Terry M
TM
Roger
Véronique L
VL
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012042:Registries; D019233:Retreatment / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017678:Sex Distribution; D015607:Stents / Q000706:statistics & numerical data