Coronary revascularisation, either by coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI), is one of the most commonly performed procedures in the USA.  Over the last ten years a number of technological and pharmacological improvements have changed the landscape of coronary revascularisation and led to a number of changes in guidelines and appropriateness criteria.  In this study, Epstein et al. set out to study the time trends in the rates and types of coronary revascularisations performed in the USA between 2001 and 2008.

To do so they examine data available from the Healthcare Cost and Utilzation Project’s Nationwide Inpatient Sample, supplemented by Medicare outpatient hospital claims.  A 15% decrease in (P<0.001) in the annual rate of coronary revascularisations was observed between 2001 and 2008.  In particular the annual CABg surgery rate decreased from 1742 CABG surgeries per million adults per year in 2001-2002 to 1081 by 2007-2008 (P<0.001).  However, over this same time period PCI rates remained unchanged (3827 PCI per million adults in 2001-2002 vs. 3667 in 2007-2008; P=0.74).  It was also seen that over this time period the number of hospitals providing CABG increased by 12%, while the number of hospitals offering PCI increased by 26%.

Conclusions:

Over the last decade, a substantial decrease in CABG rates has been seen in many US hospitals, while PCI utilisation rates have remained relatively unchanged.

• Epstein AJ, Polsky D, Yang F et al.  Coronary Revascularization Trends in the United States, 2001-2008.  JAMA 2011;305:1769.