title: Trends in coronary revascularization in the United States from 2001 to 2009: recent declines in percutaneous coronary intervention volumes.
abstract: BACKGROUND
  There is speculation that the volume of percutaneous coronary interventions (PCIs) has been decreasing over the past several years. Published studies of PCI volume have evaluated regional or hospital trends, but few have captured national data. This study describes the use of coronary angiography and revascularization methods in Medicare patients from 2001 to 2009.
  
  
  RESULTS
  This retrospective study used data from the Centers for Medicare & Medicaid Services from 2001 to 2009. The annual number of coronary angiograms, PCI, intravascular ultrasound, fractional flow reserve, and coronary artery bypass graft (CABG) surgery procedures were determined from billing data and adjusted for the number of Medicare recipients. From 2001 to 2009, the average year-to-year increase for PCI was 1.3% per 1000 beneficiaries, whereas the mean annual decrease for CABG surgery was 5%. However, the increase in PCI volume occurred primarily from 2001 to 2004, as there was a mean annual rate of decline of 2.5% from 2004 to 2009; similar trends were seen with diagnostic angiography. The use of intravascular ultrasound and fractional flow reserve steadily increased over time.
  
  
  CONCLUSIONS
  This study confirms recent speculation that PCI volume has begun to decrease. Although rates of CABG have waned for several decades, all forms of coronary revascularization have been declining since 2004.
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Riley
authors.forename: Creighton W
authors.initials: CW
authors.lastname: Don
authors.forename: Wayne
authors.initials: W
authors.lastname: Powell
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Larry S
authors.initials: LS
authors.lastname: Dean
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data* / Q000639:trends*; D017023:Coronary Angiography / Q000706:statistics & numerical data / Q000639:trends; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data / Q000639:trends; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data / Q000639:trends; D014481:United States / Q000453:epidemiology