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Coronary Revascularization Trends Shaping CABG Today

Coronary revascularization is among the most common hospital-based major interventional procedures performed in the United States. To determine how new revascularization technologies, new clinical evidence from trials, and updated clinical guidelines have influenced the volume and distribution of coronary revascularizations in the last decade, researchers from the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania examined national time trends in the rates and types of coronary revascularizations.

Researchers conducted a serial cross-sectional study with time trends of patients undergoing coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCIs) between 2001 and 2008 at U.S. hospitals in the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample, which reports inpatient coronary revascularizations. This was supplemented by Medicare outpatient hospital claims, annual procedure rates of coronary revascularizations, CABG surgery and PCI.

They found that between 2001 and 2008, the annual rate of coronary artery bypass graft surgeries performed in the United States decreased by more than 30 percent, but PCI rates did not change significantly. The results suggest the possibility that several thousand patients who underwent PCI in 2008 would have undergone CABG surgery had patterns of care not changed markedly between 2001 and 2008. Their data implied a sizeable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous, catheter-based interventions, even though the number of hospitals that perform CABG has increased.

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References: Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW, “Coronary Revascularization Trends in the United States, 2001-2008,” JAMA 2011; 305(17): 1769-1776. (Transonic Reference # 9542AHR) Canver CC, Chanda J, “Transit-Time Ultrasound Flowmeter: An Essential Intraoperative Tool for Assessing Anastomostic Quality of Coronary Bypass Graft,” 2000; IX: 227-30. (Transonic Reference # 1308AH) Bauer SF, Bauer K, Ennker IC, Rosendahl U, Ennker J, “Intraoperative bypass flow measurement reduces the incidence of postoperative ventricular fibrillation and myocardial markers after coronary revascularisation,” Thorac Cardiovasc Surg. 2005; 53(4): 217-22. (Transonic Reference # 6997AH)