PCI, CABG rates march steadily lower in Mass.

Coronary revascularization rates dipped by 39 percent over a decade in Massachusetts, according to an analysis published online Jan. 5 in JAMA Internal Medicine. Elective PCIs saw the steepest decline.

Robert W. Yeh, MD, of Massachusetts General Hospital in Boston, and colleagues retrospectively assessed all residents in Massachusetts who underwent inpatient or outpatient PCI or CABG between April 2003 and September 2012. They used U.S. census data for the general state population figures.

Overall, they found 171,702 revascularization procedures had been performed in nonfederal facilities in the state, with about three-quarters as PCIs. Overall, the revascularization rate dropped from 423 per 100,000 to 258 per 100,000 for a 39 percent drop.

For PCIs, the rate decreased from 318 per 100,000 to 200 per 100,000. The rate for CABG procedures fell as well, from 113 to 63 per 100,000.

Elective PCIs experienced an almost 50 percent drop, from 206 to 109 per 100,000 over the period. Urgent PCIs had a less dramatic drop, from 119 to 100 per 100,000. Elective and urgent CABG rates also slipped lower, at 82 to 45 per 100,000 and 31 to 18 per 100,000, respectively.

Yeh and colleagues noted that the declines they found mirror patterns reported in other populations. They attributed the reductions to improvements in primary and secondary prevention, awareness of appropriate use criteria for PCI and the impact of clinical trial results on practice.