Percutaneous coronary intervention (PCI) rates dropped by almost 10% between 2010 and 2017, according to a new analysis published in JAMA Cardiology.
A 34% decline in elective PCI rates between 2010 and 2013 was the main catalyst for the overall decrease.
“These trends differ from prior studies that showed a greater decline (approximately 23%) in PCIs over the same period, which is most likely explained by the exclusion of outpatient PCIs in previous studies,” wrote lead author Zaid I. Almarzooq, MBBCh, a cardiologist at Brigham and Women’s Hospital, and colleagues.
Almarzooq et al. analyzed 333,819 patients who underwent PCI between January 2010 and December 2017 in Florida, Michigan, Maryland or New York. While 68% of the cohort was female, the mean age was 65.7 years old.
Of the1,044,698 PCIs performed, 448,571 (42.9%) were considered urgent and 596,127 (57.1%) were performed on an elective basis.
The researchers found that between 2010 and 2017, PCI rates fell from 260.2 per 100,000 to 232.8, (10.5%). This was attributed to a decline in elective PCI rates from 165.3 per 100,000 to 123.6, (34%).
In addition, a 15% increase in urgent PCI rates was reported.
According to the authors, the decrease (23.8%) in elective PCI happened between 2010 and 2013. Subsequently, PCI rates remained relatively stable.
When comparing the inpatient and outpatient settings, inpatient PCI rates declined from 226.4 per 100,000 to 166.2 (26.6%) while outpatient PCI rates rose from 33.8 per 100,000 to 66.7 (97%).
The authors also cited clinical trials that have underscored the role of medical therapy in the initial management of stable ischemic heart disease compared with PCI.
“The shift of PCIs from the inpatient to outpatient setting likely reflects changes in payment rules and incentives favoring outpatient procedures, as well as evidence demonstrating safety of same-day discharge after PCI,” wrote Almarzooq and colleagues.
Read the full research letter here.