In-hospital outcomes after percutaneous coronary intervention in Canada: 1992/93 to 2000/01.

BACKGROUND Despite existing research on outcomes of cardiac care in Canada, little is known about Canada-wide trends and interprovincial differences in outcomes after percutaneous coronary intervention (PCI). OBJECTIVES To examine Canadian trends in rates of in-hospital mortality and same-admission coronary artery bypass grafting (CABG) after PCI and to compare provincial risk-adjusted in-hospital death and same-admission CABG rates. METHODS Hospital discharge abstract data were obtained from the Canadian Institute for Health Information and were used to identify cohorts of patients who underwent PCI in eight provinces in fiscal years 1992/93 through 2000/01. Crude data from Quebec hospitals were available for calendar years 1998 and 1999. Logistic regression modelling was used to calculate risk-adjusted in-hospital death and same-admission CABG rates by year and province. RESULTS A total of 127,103 PCI cases performed in 23 hospitals across eight provinces were examined, with an overall unadjusted death rate of 1.4% and an overall unadjusted CABG rate of 1.6%. A national trend of stable in-hospital mortality rates was observed with a risk-adjusted death rate of 1.4% in 1992/93 versus 1.4% in 2000/01. An overall decline was seen in rates of same-admission CABG with a risk-adjusted rate of 2.7% in 1992/93 versus 0.9% in 2000/01 (relative decrease 67%, P<0.01). New Brunswick, Manitoba and British Columbia achieved overall declines in risk-adjusted death rates over the study period, while the other provinces experienced a slight increase (Newfoundland, Nova Scotia, Ontario, Alberta and Saskatchewan). All provinces displayed a similar decline in risk-adjusted same-admission CABG rates post-PCI. INTERPRETATION Risk-adjusted rates of in-hospital death after PCI in Canada have remained stable over nine years, while risk-adjusted rates of same-admission CABG have decreased. The presence of interprovincial differences in risk-adjusted outcomes raises the possibility of variable quality of care for patients undergoing PCI across the Canadian provinces.

[1]  E. Topol,et al.  Practice patterns and outcomes of percutaneous coronary interventions in the United States: 1995 to 1997. , 2002, The American journal of cardiology.

[2]  William S Weintraub,et al.  Development of a risk adjustment mortality model using the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) experience: 1998-2000. , 2002, Journal of the American College of Cardiology.

[3]  J. Tu,et al.  A Canadian comparison of data sources for coronary artery bypass surgery outcome "report cards". , 2000, American heart journal.

[4]  J. Spinelli,et al.  Improved clinical outcome after widespread use of coronary-artery stenting in Canada. , 1999, The New England journal of medicine.

[5]  C. Naylor,et al.  Trends in clinical and economic outcomes of coronary angioplasty from 1992 to 1995: a population-based analysis. , 1999, American heart journal.

[6]  S. Pocock,et al.  A Clinical Trial Comparing Three Antithrombotic-Drug Regimens after Coronary-Artery Stenting , 1998 .

[7]  R. Berenson,et al.  A comparison of cardiovascular procedure use between the United States and Canada. , 1998, Health services research.

[8]  M Pine,et al.  Predictions of Hospital Mortality Rates: A Comparison of Data Sources , 1997, Annals of Internal Medicine.

[9]  M. Hadamitzky,et al.  A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. , 1996, The New England journal of medicine.

[10]  R E Hall,et al.  Searching for an improved clinical comorbidity index for use with ICD-9-CM administrative data. , 1996, Journal of clinical epidemiology.

[11]  L. Iezzoni,et al.  Judging hospitals by severity-adjusted mortality rates: the case of CABG surgery. , 1996, Inquiry : a journal of medical care organization, provision and financing.

[12]  P Hall,et al.  Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. , 1995, Circulation.

[13]  D. Pryor,et al.  Changes in Mortality after Myocardial Revascularization in the Elderly: The National Medicare Experience , 1994, Annals of Internal Medicine.

[14]  R. Califf,et al.  Scorecard Cardiovascular Medicine: Its Impact and Future Directions , 1994, Annals of Internal Medicine.

[15]  H. Luft,et al.  Coronary Angioplasty Statewide Experience in California , 1993, Circulation.

[16]  J. Chiota.  Percutaneous transluminal coronary angioplasty in New York State. , 1993, JAMA.

[17]  E L Hannan,et al.  Clinical Versus Administrative Data Bases for CABG Surgery: Does it Matter , 1992, Medical care.

[18]  P Sharkey,et al.  The importance of severity of illness in assessing hospital mortality. , 1990, JAMA.

[19]  F Joffre,et al.  Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. , 1987, The New England journal of medicine.

[20]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[21]  L Campolo,et al.  [Coronary angioplasty]. , 1982, Giornale italiano di cardiologia.

[22]  P. Loy.  International Classification of Diseases--9th revision. , 1978, Medical record and health care information journal.