Temporal trends in the use of percutaneous coronary intervention and coronary artery bypass surgery in New York State and Ontario.
BACKGROUND
Healthcare reform initiatives in the United States have rekindled debate about the role of government regulation in the healthcare system. Although New York State (NYS) historically has had twice as many coronary revascularizations performed as Ontario, the relative evolution of coronary revascularization patterns in both jurisdictions over time is unknown.


RESULTS
We conducted an observational study comparing the temporal trends of cardiac invasive procedures use in NYS and Ontario using population-based data from 1997 to 2006 stratified by procedure indication. For nonacute myocardial infarction patients, the age- and sex-adjusted rate of percutaneous coronary intervention (PCI) was 2.3 times (95% confidence interval, 2.2 to 2.5) greater in NYS than in Ontario in 2004 to 2006. In contrast, population-based rates of coronary artery bypass grafting among nonacute myocardial infarction patients were not significantly different. For acute myocardial infarction patients, differences in coronary revascularization rates between NYS and Ontario narrowed substantially over time. In 2004 to 2006, the relative ratio was 1.3 times higher for PCI (95% confidence interval, 1.2 to 1.5) and 1.4 times higher (95% confidence interval, 1.1 to 1.8) for coronary artery bypass grafting in NYS relative to Ontario. However, a larger relative gap (relative ratio, 2.0; 95% confidence interval, 1.7 to 2.3) was observed among acute myocardial infarction patients undergoing emergency PCIs in NYS compared with Ontario.


CONCLUSIONS
The market-oriented financing approach in NYS is associated with markedly higher rates of PCI procedures for both discretionary indications (eg, PCI in nonacute myocardial infarction patients) and emergent indications (eg, primary PCI) compared with the government-funded single-payer system in Ontario.
Institute for Clinical Evaluative Sciences, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Ontario, Canada.
Dennis T
DT
Ko
Jack V
JV
Tu
Zaza
Z
Samadashvili
Helen
H
Guo
David A
DA
Alter
Warren J
WJ
Cantor
Edward L
EL
Hannan
D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D002170:Canada / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D003324:Coronary Artery Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care; D005260:Female; D017048:Health Care Costs; D018166:Health Care Reform; D019981:Health Care Sector; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D009518:New York / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018855:Single-Payer System; D014850:Waiting Lists