353. Over Utilization of PCI in New York State
Robert F. Tranbaugh1, Katherine M. Driscoll2, Berhane M. Worku1, Ivan M. Gambardella1, *Anthony J. Acinapura3, Terrence J. Sacchi3, Sorin J. Brenner3, *Leonard N. Girardi1
1Weill Cornell Medicine, New York, NY;2Cornell University, Ithaca, NY;3New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
Invited Discussant: *John S. Ikonomidis
Objective: Discrepancies in PCI versus CABG utilization within New York State (NYS) have been well documented through 2008. After the 2007 COURAGE trial showing no benefit of PCI over medical therapy, we sought to further examine these trends and compare NYS PCI versus CABG rates to national trends through 2014.
Methods: The number of PCI, CABG, and the calculated PCI/CABG ratios were compiled using publicly available NYS Department of Health (www.health.ny.gov/statistics/disease/cardiovascular since 1993) and American Heart Association (available at www.ahajournals.org since 2003) published yearly reports.
Results: Figure 1 shows that PCI cases rose 167% between 1995 and 2006 (21,707 to 57,944 cases), while CABG fell 40% (19,995 to 11,929 cases) in NYS. Post COURAGE trial, the NYS PCI caseload declined only 15% between 2006 and 2015, reaching 49,035 cases while CABG volume fell 30% to 8,356. In contrast as seen in figure 2, from 2006 to 2014, the number of national PCI cases fell 63% (1,313,000 to 480,000) while national CABG cases fell only 17% (448,000 to 371,000). For the post COURAGE trial period from 2006 to 2014, the corresponding national PCI/CABG ratio fell 59% from 2.9 to 1.2 (p<0.001) while the NYS PCI/CABG ratio actually increased 28% from 4.6 to 5.9 (p<0.001).
Conclusions: Despite the dramatic decline in national PCI volume and national PCI/CABG ratio, the NYS PCI volume remains consistently high resulting in a markedly elevated NYS PCI/CABG ratio. PCI is clearly over utilized in NYS and this disparity suggests opportunities to examine and better monitor appropriateness of PCI use to ensure that patients are receiving optimal, evidence-based therapy for multivessel coronary artery disease.