title: Changes in the Practice of Coronary Revascularization between 2006 and 2010 in the Republic of Korea.
abstract: OBJECTIVE
  Evidence suggests that technological innovations and reimbursement schemes of the National Health Insurance Service may have impacted the management of coronary artery disease. Thus, we investigated changes in the practice patterns of coronary revascularization.
  
  
  METHODS
  Revascularization and in-hospital mortality among Koreans ≥20 years old were identified from medical claims filed between 2006 and 2010. The age- and sex-standardized procedure rate per 100,000 person-years was calculated directly from the distribution of the 2008 Korean population.
  
  
  RESULTS
  The coronary revascularization rate increased from 116.1 (95% confidence interval, 114.9-117.2) in 2006 to 131.0 (129.9-132.1) in 2010. Compared to the rate ratios in 2006, the rate ratios for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in 2010 were 1.16 (1.15-1.17) and 0.80 (0.76-0.84), respectively. Among patients who received PCI, the percentage with drug-eluting stents increased from 89.1% in 2006 to 93.0% in 2010. In-hospital mortality rates from PCI significantly increased during the study period (p=0.03), whereas those from CABG significantly decreased (p=0.01). The in-hospital mortality rates for PCI and CABG were higher in elderly and female patients and at the lowest-volume hospitals.
  
  
  CONCLUSIONS
  The annual volume of coronary revascularization continuously increased between 2006 and 2010 in Korea, although this trend differed according to procedure type. A high percentage of drug-eluting stent procedures and a high rate of in-hospital mortality at low-volume hospitals were noted.
authors.affiliation: Health Technology Assessment Team, Health Insurance Review and Assessment Service, Seoul, Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
authors.forename: Jin-Bae
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Health Technology Assessment Team, Health Insurance Review and Assessment Service, Seoul, Korea.
authors.forename: Su-Jin
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jaelim
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jungwoo
authors.initials: J
authors.lastname: Sohn
authors.affiliation: National Cancer Center, Goyang, Korea.
authors.forename: Seong-Kyung
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyoung Hwa
authors.initials: KH
authors.lastname: Ha
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. preman@yuhs.ac.
authors.forename: Changsoo
authors.initials: C
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data* / Q000639:trends; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000639:trends*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data* / Q000639:trends; D056910:Republic of Korea / Q000453:epidemiology
keywords: Myocardial revascularization; insurance; percutaneous coronary intervention; reimbursement