title: Trends in the use of diagnostic coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft surgery across North Carolina.
abstract: BACKGROUND
  Although variation in use of invasive coronary procedures has been shown, the relationship between invasive diagnostic cardiac catheterization (Cath) and subsequent revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is not known. We evaluated the temporal trends and variation in invasive Cath, PCI, and CABG across hospital systems in North Carolina.
  
  
  METHODS
  All Cath, PCI, and CABG procedures performed in North Carolina from 2003 to 2009 were identified using data reported in the annual North Carolina State Medical Facilities Plan. Rates and variation in procedure use, relative rates of PCI to Cath, CABG to Cath, and CABG to PCI were compared over the study period between hospitals that performed at least 25 Cath, 25 PCI, and 25 CABG procedures.
  
  
  RESULTS
  The rates of all invasive procedures per 100,000 population declined: 24% for Cath, 16% for PCI, and 35% for CABG. However, the relative rate of PCI to Cath over the study period increased by 11%, whereas the relative rate of CABG to Cath decreased by 13%. Hospital level analysis showed significant variation in the relative rate of both PCI to Cath (10%-90%, P < .05) and CABG to Cath (5%-35%, P < .05).
  
  
  CONCLUSIONS
  Although the use of all invasive cardiac procedures declined, the relative rate of PCI to Cath increased over the study period. There was also significant variation in the mode of revascularization (CABG and PCI) across hospital systems in North Carolina. Further research is needed to understand drivers of coronary revascularization.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA. jones298@mc.duke.edu
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.forename: Sara A
authors.initials: SA
authors.lastname: Holleran
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Harry R
authors.initials: HR
authors.lastname: Phillips
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D013504:Cardiovascular Surgical Procedures / Q000639:trends; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D003935:Diagnostic Techniques, Cardiovascular / Q000639:trends; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D009657:North Carolina; D017063:Outcome Assessment, Health Care