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Major geographical variations in elective coronary revascularization by stents or surgery in England

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

Baig SS, Altman DG, Taggart DP

Reference

Eur J Cardiothorac Surg. 2015 May;47(5):855-9

Published

2015 May

Link

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My Comment

Background

Myocardial revascularization can be achieved through two interventions: percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The decision on the revascularization modality should be done according to the patient’s age, pattern of coronary artery disease, comorbidities and patient preferences, as indicated in the current European Society of Cardiology and European Association for Cardio-Thoracic Surgery guidelines (2010). The authors report on geographical variation in elective coronary revascularization practices throughout England.

Results

  • Data on myocardial revascularization in 2010/2011 was obtained from 151 primary care trusts (PCTs) in England.
  • The mean of the combined total of CABG and PCI per PCT was 297 (range 75-1213).
  • The degree of variation in PCI/CABG ratio ranged between 0.36 and 4.74 (median 1.19, first quartile 0.98, third quartile 1.73).
  • PCI/CABG ratio did not correlate with the centre volume interventions performed.

My comments

There are multiple factors influencing the PCI/CABG ratio. Similarly to recent studies from Canada and Australia, Baig et al. present a very high variability of the PCI/CABG ratio up to 13-fold difference between North Tyneside and Darlington, two areas that are geographically very close to each other. It seems that in reality the decision whether PCI or CABG will be performed depends only partly on the guidelines and is rather accounted by practitioner preference. Unfortunately, patients in certain regions are less likely to receive the optimal treatment. This study underlines the importance of respecting the international guidelines and a multidisciplinary team approach for coronary revascularization (The Heart Team).

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