Determinants of percutaneous coronary intervention vs coronary artery bypass grafting: an interprovincial comparison.
BACKGROUND
Marked variation exists concerning the utilization of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The objective of this study was to examine differences in predictors of mode of revascularization across 3 provincial jurisdictions.


METHODS
All patients who underwent PCI and isolated CABG in British Columbia, Alberta, and Nova Scotia between 1996 and 2007 were considered. Age- and sex-standardized rates of PCI and CABG per 100,000 population and PCI to CABG ratios were calculated by year and province. Logistic regression models were constructed to identify independent predictors of mode of revascularization in each province.


RESULTS
A total of 32,190 and 69,409 patients underwent CABG and PCI, respectively, during the study period. Significant increases in the age- and sex-adjusted PCI to CABG ratios were observed in all 3 provinces, but these ratios differed between provinces. Across all 3 jurisdictions, female sex and diagnosis of acute coronary syndrome favoured increased PCI vs CABG, and increased age, left main, or 3-vessel disease occurring before myocardial infarction, and diabetes favoured lower PCI vs CABG. After adjusting for clinical and angiographic factors, there remained a significant variation in choice of PCI vs CABG between the 3 provinces over time.


CONCLUSIONS
Significant interprovincial variability in PCI to CABG ratios was observed. Though certain patient-related factors predictive of either PCI or CABG were identified, factors beyond clinical presentation played a role in the choice of revascularization approach.
Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Maral
M
Ouzounian
William
W
Ghali
Alexandra M
AM
Yip
Karen J
KJ
Buth
Karin
K
Humphries
Therese A
TA
Stukel
Colleen M
CM
Norris
Danielle A
DA
Southern
P Diane
PD
Galbraith
Christopher R
CR
Thompson
James
J
Abel
Michael P
MP
Love
Ansar
A
Hassan
Gregory M
GM
Hirsch
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002309:Cardiology; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013219:State Government; D000078329:Workforce; D055815:Young Adult