Robert Tranbaugh

Myocardial Revascularization in New York State: Variations in the PCI‐to‐CABG Ratio and Their Implications

Background During the past 2 decades, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among hospitals and regions. Methods and Results We reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 through 2008 to define trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of the State. During this 15-year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries, and for PCI for New York State were −40%, −20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were similar as follows: −61%, −23%, +14%, and +284%. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; however, in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher than the ratios for New York City programs outside Manhattan, in Long Island, in the northern counties contiguous to New York City, and in the rest of New York State; their averages were 5.84, 5.38, 3.31, and 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared with the rest of New York State; in one Manhattan program, the likelihood was 215% higher. Conclusions There are substantial regional and statewide differences in the utilization of PCI versus CABG among cardiac centers in New York, possibly related to patient characteristics, physician biases, and hospital culture. Understanding these disparities may facilitate the selection of the most appropriate, effective, and evidence-based revascularization strategy. (J Am Heart Assoc. 2012;1:e001446 doi: 10.1161/JAHA.112.001446.)

Reply: CABG Versus PCI: Are All Revascularization Strategies Created Equal?

We thank Drs. Philip and Southard for their comments on our study comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) outcomes [(1)][1]. They raised 2 concerns or limitations that they suggest “will dampen the enthusiasm for the use of multiple arterial

Coronary artery bypass graft (CABG) and the diabetic patient: current perspectives

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Research Reports in Clinical Cardiology 2014:5 57–67 Research Reports in Clinical Cardiology Dovepress

CABG VERSUS PCI: THE EFFECT OF MULTIPLE ARTERIAL GRAFTING ON SURVIVAL

Previous comparisons of coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) using stents have included very few CABG patients receiving multiple arterial bypass grafts (MABG) as opposed to a single left internal thoracic artery (SITA). We thus sought to determine if MABG,

OPTIMAL GRAFTING STRATEGY FOR MULTIVESSEL CORONARY ARTERY BYPASS SURGERY

The optimal grafting strategy during CABG is not clear beyond the LITA-LAD graft. We compared late survival in patients receiving either the radial artery (RA), right internal thoracic artery (RITA) or saphenous vein (SVG) as the preferred second graft. Late survival data was collected for 13,130