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Choice of PCI or CABG Depends on Many Factors

Opportunities exist to improve transparency and consistency around decision-making

Choosing between percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) is strongly related to the physician diagnosing the condition and the treating hospital, according to a study published on December 12, 2011 on the Canadian Medical Association Journal website.

The ratio of PCI to CABG varies widely between hospitals and regions. As PCI has evolved, its expanded use has increased the PCI to CABG ratio from 1.6 in 2001 to 2.7 in 2006, which is partially due to increased use in treating multi-vessel disease. To investigate further, the authors retrospectively reviewed the charts of a population-based sample of patients to identify clinical and nonclinical factors associated with variations in the PCI to CABG ratio across 17 cardiac centers in Ontario, Canada.

The study included 8,972 patients who underwent PCI or CABG from April 2006 to March 2007. Hospitals were classified into four groups, depending on their PCI to CABG ratio: low (lower than 2.0); low-medium (2.0 to 2.7); medium-high (2.7 to 3.2); and high (more than 3.2). The mean ratio was 2.7, although it ranged from 1.6 in the low group to 4.6 in the high group. The strongest predictors of choosing PCI over CABG were coronary anatomy, followed by the clinical indication for the procedure and the hospital where the procedure was performed. More than 88 percent of the patients with single-vessel disease received PCI and most patients with left main artery disease received CABG. There was also a strong correlation between the treatment recommendation by the physician who performed the diagnostic catheterization, and the authors noted a "cultural" effect in which noninterventional cardiologists at centers in the high ratio category were more likely than those at low ratio centers to recommend PCI.

The authors write that the results of the current study suggest that "cardiac surgeons need to be more involved in clinical decision-making when patients are candidates for either PCI or CABG surgery. Patients need to be fully informed about the benefits and risks of all alternative treatment options."

Source: Tu JV, Ko DT, Guo H, et al. 2011. Determinants of variations in coronary revascularization practices. Published on December 12, 2011 on the Canadian Medical Association Journal website.