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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Public Reporting and Case Selection for Percutaneous Coronary Interventions

An Analysis From Two Large Multicenter Percutaneous Coronary Intervention Databases

Mauro Moscucci, MD^_*,_*, Kim A. Eagle, MD^_*, David Share, MD, MPH, Dean Smith, PhD, MS^_*, Anthony C. De Franco, MD, Michael O’Donnell, MD, Eva Kline-Rogers, RN, MS^_*, Sandeep M. Jani, MPH^_* and David L. Brown, MD^||

^_* University of Michigan Health System, Ann Arbor, Michigan
Blue Cross Blue Shield Center for Health Care Quality, Detroit, Michigan
McLaren Regional Medical Center, Flint, Michigan
St. Joseph Mercy Hospital, Ann Arbor, Michigan
^|| State University of New York-Stony Brook School of Medicine, Stony Brook, New York

Manuscript received September 10, 2004; revised manuscript received January 13, 2005, accepted January 17, 2005.

^_* Reprint requests and correspondence: Dr. Mauro Moscucci, Taubman Center B1-226, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0311. (Email: moscucci{at}umich.edu).

OBJECTIVES: The purpose of this research was to determine the potential effect of public reporting on case selection for percutaneous coronary intervention (PCI).

BACKGROUND: Previous studies have suggested that public reporting of coronary artery bypass graft surgery (CABG) mortality might result in case selection bias and in denial of care to or out migration of high-risk patients. The potential effect of public reporting on case selection for PCI is unknown.

METHODS: We compared demographics, indications, and outcomes of 11,374 patients included in a multicenter (eight hospitals) PCI database in Michigan where no public reporting is present, with 69,048 patients in a statewide (34 hospitals) PCI database in New York, where public reporting is present. The primary end point was in-hospital mortality.

RESULTS: Patients in Michigan more frequently underwent PCI for acute myocardial infarction (14.4% vs. 8.7%, p < 0.0001) and cardiogenic shock (2.56% vs. 0.38%, p < 0.0001) than those in New York. The Michigan cohort also had a higher prevalence of congestive heart failure and extracardiac vascular disease. The unadjusted in-hospital mortality rate was significantly lower in New York than in Michigan (0.83% vs. 1.54%, p < 0.0001; odds ratio [OR] 0.54, 95% confidence interval [CI] 0.45 to 0.63). However, after adjustment for comorbidities, there was no significant difference in mortality between the two groups (adjusted OR 1.05, 95% CI 0.84 to 1.31, p = 0.70, c-statistic 0.88).

CONCLUSIONS: There are significant differences in case mix between patients undergoing PCI in Michigan and New York that result in marked differences in unadjusted mortality rates. A propensity in New York toward not intervening on higher-risk patients because of fear of public reporting of high mortality rates is a possible explanation for these differences.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CI = confidence interval   MI = myocardial infarction   OR = odds ratio   PCI = percutaneous coronary intervention

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