CRT: In-hospital death rates decline for PCI, CABG

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Washington, D.C.—The age-adjusted in-hospital mortality rate from both PCI and CABG has declined to its lowest level in 2004, according to two separate studies presented at the Cardiovascular Research Technologies (CRT) meeting last week.

The authors said that “significant advances” in surgical techniques, post-surgical care and PCI-related technologies over the past decade have made the difference.

Mohammad Reza Movahed, MD, from the Southern Arizona VA Health Care System in Tucson, Ariz., and colleagues said their goal of the PCI study was to evaluate age-adjusted in-hospital mortality rate in patients undergoing PCI based on race and gender from 1988 to 2004. The goal of the CABG study was to evaluate any decline in the age adjusted in-hospital mortality rate of patients undergoing CABG using a large database from 1989 to 2004 in the U.S.

For both studies, the researchers assessed the Nationwide Inpatient Sample (NIS) database, evaluating patients over the age of 40 using specific ICD-9-CM codes. They calculated total and age adjusted mortality rates per 100,000 for these periods.

For the PCI trial, the mean age was 71.5 years (53.5 percent). From 1988 to 1995, Movahed and colleagues found that the age-adjusted mortality rate was stable. However, after 1995, the age-adjusted mortality rate showed persistent decline to the lowest level in 2004. In 1988, age-adjusted mortality rate was 75.4 per 100,000; in 1995, 66.8 per 100,000; and in 2004, 38.3 per 100,000.

Total deaths also declined from 1.8 percent to 1.2 percent. This trend was similar across gender and ethnic groups except Asians. Furthermore, minorities and women had persistently higher mortality in comparison to men and Caucasians, according to the authors.

For the CABG trial, the NIS database contained 1.15 million patients who had CABG performed with a mean age of 71 years. From 1989, the age-adjusted rate for all CABG related mortality had been decreasing steadily to reach the lowest level in 2004 -- 300.3 per 100,000 in 1989 and 104.6 per 100,000 in 2004. Total deaths also declined from 5.5 percent to 3.06 percent.

For the PCI trial, the age-adjusted in-hospital mortality rate was steady until 1995, and declined to its lowest level in 2004. “Despite this decline, racial and gender disparity in regards to mortality persisted over the study years,” Movahed and colleagues wrote.

Also, the age adjusted in-hospital mortality from CABG has been declining steadily to the lowest level in 2004, which the authors said “most likely reflects advancements in surgical technique and post-surgical care.”