title: Trends in Coronary Revascularization and Ischemic Heart Disease-Related Mortality in Israel.
abstract: We investigated national trends in volume and outcomes of percutaneous coronary angioplasty (PCI), coronary artery bypass grafting (CABG), and ischemic heart disease-related mortality in Israel.
  
  
  
  UsingInternational Classification of Diseases9th and 10th revision codes, we linked 5 Israeli national databases, including the Israel Center for Disease Control National PCI and CABG Registries, the Ministry of Health Hospitalization Report, the Center of Bureau of Statistics, and the Ministry of Interior Mortality Report, to assess the annual PCI and CABG volume, procedural mortality, comorbidities, and ischemic heart disease-related mortality between 2002 and 2014. Trends over time were analyzed using linear regression, assuming a Poisson distribution. A total of 298 390 revascularization procedures (PCI: 255 724, CABG: 42 666) were performed during the study period. PCI volume increased by 9% from 2002 to 2008 (387.4/100 000 to 423.2/100 000), steadily decreasing by 10.5% to 378.5/100 000 in 2014 (P=0.70 for the trend). CABG volume decreased by 59% (109.0/100 000 to 45.2/100 000) from 2002 to 2013, leveling at 46.4/100 000 (P<0.0001). PCI/CABG ratio increased from 3.6 in 2002 to 8.5 in 2013, slightly decreasing to 8.2 by 2014 (P<0.0001). In-hospital procedural mortality remained stable (PCI: 1.2-1.6%,P=0.34, CABG: 3.7-4.4%,P=0.29) despite a significant change in patient clinical profile. During the course of the study, ischemic heart disease-related mortality decreased by 46% (84.6-46/100 000,P<0.001).
  
  
  
  We observed a dramatic change in coronary revascularization procedures type and volume, and a marked decrease in ischemic heart disease-related mortality in Israel. The reasons for the observed changes remain unclear and need to be further investigated.
authors.affiliation: Israel Centers for Disease Control, Ministry of Health, Ramat Gan, Israel orit.blumenfeld@moh.health.gov.il.
authors.forename: Orit
authors.initials: O
authors.lastname: Blumenfeld
authors.affiliation: Israel Centers for Disease Control, Ministry of Health, Ramat Gan, Israel.
authors.forename: Wasef
authors.initials: W
authors.lastname: Na'amnih
authors.affiliation: Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Shapira-Daniels
authors.affiliation: Department of Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.affiliation: Israel Centers for Disease Control, Ministry of Health, Ramat Gan, Israel.|Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Tamy
authors.initials: T
authors.lastname: Shohat
authors.affiliation: Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Oz M
authors.initials: OM
authors.lastname: Shapira
mesh_terms: D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: coronary disease; population; revascularization; survival