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CLINICAL RESEARCH: CORONARY REVASCULARIZATION

Coronary Revascularization in the Community

A Population-Based Study, 1990 to 2004

Yariv Gerber, PhD^_*,,, Charanjit S. Rihal, MD^_*, Thoralf M. Sundt, III, MD^_*, Jill M. Killian, BS, Susan A. Weston, MS, Terry M. Therneau, PhD and Véronique L. Roger, MD, MPH^_*,,1,_*

^_* Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.

Manuscript received January 2, 2007; revised manuscript received May 22, 2007, accepted June 19, 2007.

^_* Reprint requests and correspondence: Dr. Véronique L. Roger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: roger.veronique{at}mayo.edu).

Objectives: We sought to examine temporal trends in the utilization of coronary revascularization in a geographically defined population.

Background: Earlier reports on revascularization utilization focused on inpatient settings and did not distinguish incident from recurrent procedures. Furthermore, little is known on age- and gender-specific trends. Finally, longitudinal data on the utilization and results of coronary angiography as explanatory factors for the changing revascularization practice are lacking.

Methods: Data integrating diagnostic and therapeutic coronary procedures performed in Olmsted County (Minnesota) between 1990 and 2004 were analyzed. Standardized rates were calculated applying the direct method and temporal trends compared using Poisson regression models.

Results: Revascularization utilization increased by 24% during the study (95% confidence interval [CI] 5% to 46%), but the trends diverged by procedure type, with a sustained increase (69%, 95% CI 43% to 101%) for percutaneous coronary interventions (PCI) contrasting with a stabilization, then decline (–33%, 95% CI –16% to –47%) for coronary artery bypass grafting (CABG). For PCI, although the use increased in all categories, greater increases were noted in the elderly, in women, and for recurrent procedures. No such patterns were detected for CABG. Angiography use remained stable, and the rate of 3-vessel and/or left main disease declined (–22%, 95% CI –8% to –33%).

Conclusions: Over the 15-year period, revascularization increased in the community with a large increase in PCI partially offset by a decrease in CABG. More PCIs are performed in women and the elderly and for recurrent disease. These changes occurred within the context of a decline in multivessel disease and thus likely reflect the natural history of coronary artery disease.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   CAD = coronary artery disease   CI = confidence interval   LM = left main   PCI = percutaneous coronary intervention   RR = rate ratio

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