Medical Student University of British Columbia Victoria, British Columbia, Canada
Background: Modern coronary revascularization began with the introduction of coronary artery bypass grafting (CABG) in the 1960s. Seventeen years later, percutaneous coronary intervention (PCI) emerged as a less invasive alternative. Advancements in PCI have reportedly significantly reduced the utilization rates of CABG, with multiple studies documenting a contemporary shift away from CABG. We studied how the utilization of revascularization modalities varied over the fifteen year period from 2010 to 2024.
METHODS AND RESULTS: We accessed the British Columbia Medical Services Plan billing records using the provincial Ministry of Health Data Platform. We included the records of all 140,101 procedures (319,491 vessel revascularizations) on all 114,144 patients aged 20-79 that underwent CABG (34,586) or PCI (105,515) from 2010 to 2024.
We considered all coronary revascularization procedures that a patient underwent within a 60-day period to be a single case. We counted the total number of vessel revascularizations billed for each case. Cases were categorized into modalities as either CABG, One-Time PCI, Staged PCI, or Combination (CABG and PCI). We analyzed the distribution across modalities of case volumes, revascularizations per case, and patient age, over time. Statistical significance in temporal trend was assessed using simple linear regression. The data are visualized in Figure 1.
There was no significant trend in the proportion of CABG cases over time (P=.984). There was a statistically significant but clinically insignificant trend of a decreased number of bypass grafts per CABG case of -0.02/year (P <.001). There were nominal trends of increasing patient age over time of 0.05 years/annum for CABG (P <.001), 0.15 years/annum for Staged PCI (P <.001), and 0.11 years/annum for Combination Revascularization (P=.02)
Across the entire study period, the mean revascularizations per case for PCI was 1.89, for CABG was 3.42, for Staged PCI was 4.35 and for Combination Revascularizations was 4.90; the average patient age was 64.1 for Staged PCI, 64.5 for PCI, 64.6 for Combination Revascularizations and 66.7 for CABG.
Conclusion: The relative use of CABG vs. PCI in British Columbia has been stable over the last 15 years. CABG accounted for the majority of 4- and 5-vessel revascularizations, while the use of Staged PCI increased progressively with the number of vessels treated.
