1. ACC.i2 Interventional Cardiology
98
JACC April 5, 2016
Volume 67, Issue 13
PRACTICE MAKES PERFECT FOR PCI, NOT FOR CABG
Poster Contributions
Poster Area, South Hall A1
Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m.
Session Title: Complex PCI: Left Main, Multi Vessel, Bifurcation
Abstract Category: 8. ACC.i2 Interventional Cardiology: Coronary Intervention: Left Main, Multivessel, Bifurcation
Presentation Number: 1107-149
Authors: Odunayo Olorunfemi, Tunde Ola, Oladimeji Akinboro, Gbolahan Ogunbayo, Shanchiya Ravindradas, Oluwatobi Adegboyega,
Rochester General Hospital, Rochester, NY, USA, New York Metropolitan Hospital Center, New York, NY
Background: We sought to describe the outcomes of two of the most commonly performed invasive procedures on the heart -
Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass grafting (CABG) with or without valve replacement.
Methods: We extracted the percutaneous coronary intervention (PCI) by cardiologist and the cardiac surgery by surgeon datasets of the
New York (NY) State Department of Health’s cardiovascular disease data and statistics for the3 year period from 2008 - 2011. We analyzed
the number of procedures, emergent and non emergent setting of the cases and whether or not a CABG involved a valve repair. We
performed logistic regression analyses for mortality as determined by the risk adjusted mortality rate.
Results: From 2008 - 2011, a total of 222,862 PCIs were completed and a total of 199,442 CABG procedures performed. 189,419 (85.0%)
of the PCIs were non-emergent while 112,622 (56.5%)of the CABG procedures did not involve valve surgery. Median risk adjusted mortality
rate was 0.5% for all PCI procedures while it was 1.92 for all CABG procedures (with or without valve procedure). The odds of a higher
than median risk adjusted mortality was significantly lower in non-emergency PCI procedures [OR 0.32; 95%CI 0.27 - 0.38; p<0.001] and
significantly higher in CABG procedures with valve involvement [OR 4.5; 95%CI 3.5 - 5.7; p<0.001]. There was a statistically significant
decline in the risk for mortality as physicians performed more PCI procedures from the 25th percentile [OR 4.8; 95%CI 3.9 -6.0], 50th-
[OR 2.0 , 95%CI 1.7 - 2.4], 75th -[OR 1.8; 95%CI 1.5 - 2.3], and the 90th percentiles[OR 1.4 , 95%CI 1.0 - 2.3] respectively. The odds for
mortality with all CABG procedures based on the number of procedures performed were 3.7 [95%CI 2.8 - 5.0] for the 25th percentile 1.8 [
95%CI 1.4 - 2.2]-50th percentile and 2.1[ 95%CI 1.5 - 2.8 ] for the 75th percentile
Conclusions: Our analysis shows that increased volume of PCIs seems to improve proficiency. In contrast, there seems to be a nadir in
odds for mortality at the median number of CABG cases performed. This finding may reflect improved techniques and proficiency in the
PCI group and/or taking on more complex cases as experience grows in the CABG group.
![ACC.i2 Interventional Cardiology
98
JACC April 5, 2016
Volume 67, Issue 13
PRACTICE MAKES PERFECT FOR PCI, NOT FOR CABG
Poster Contributions
Poster Area, South Hall A1
Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m.
Session Title: Complex PCI: Left Main, Multi Vessel, Bifurcation
Abstract Category: 8. ACC.i2 Interventional Cardiology: Coronary Intervention: Left Main, Multivessel, Bifurcation
Presentation Number: 1107-149
Authors: Odunayo Olorunfemi, Tunde Ola, Oladimeji Akinboro, Gbolahan Ogunbayo, Shanchiya Ravindradas, Oluwatobi Adegboyega,
Rochester General Hospital, Rochester, NY, USA, New York Metropolitan Hospital Center, New York, NY
Background: We sought to describe the outcomes of two of the most commonly performed invasive procedures on the heart -
Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass grafting (CABG) with or without valve replacement.
Methods: We extracted the percutaneous coronary intervention (PCI) by cardiologist and the cardiac surgery by surgeon datasets of the
New York (NY) State Department of Health’s cardiovascular disease data and statistics for the3 year period from 2008 - 2011. We analyzed
the number of procedures, emergent and non emergent setting of the cases and whether or not a CABG involved a valve repair. We
performed logistic regression analyses for mortality as determined by the risk adjusted mortality rate.
Results: From 2008 - 2011, a total of 222,862 PCIs were completed and a total of 199,442 CABG procedures performed. 189,419 (85.0%)
of the PCIs were non-emergent while 112,622 (56.5%)of the CABG procedures did not involve valve surgery. Median risk adjusted mortality
rate was 0.5% for all PCI procedures while it was 1.92 for all CABG procedures (with or without valve procedure). The odds of a higher
than median risk adjusted mortality was significantly lower in non-emergency PCI procedures [OR 0.32; 95%CI 0.27 - 0.38; p<0.001] and
significantly higher in CABG procedures with valve involvement [OR 4.5; 95%CI 3.5 - 5.7; p<0.001]. There was a statistically significant
decline in the risk for mortality as physicians performed more PCI procedures from the 25th percentile [OR 4.8; 95%CI 3.9 -6.0], 50th-
[OR 2.0 , 95%CI 1.7 - 2.4], 75th -[OR 1.8; 95%CI 1.5 - 2.3], and the 90th percentiles[OR 1.4 , 95%CI 1.0 - 2.3] respectively. The odds for
mortality with all CABG procedures based on the number of procedures performed were 3.7 [95%CI 2.8 - 5.0] for the 25th percentile 1.8 [
95%CI 1.4 - 2.2]-50th percentile and 2.1[ 95%CI 1.5 - 2.8 ] for the 75th percentile
Conclusions: Our analysis shows that increased volume of PCIs seems to improve proficiency. In contrast, there seems to be a nadir in
odds for mortality at the median number of CABG cases performed. This finding may reflect improved techniques and proficiency in the
PCI group and/or taking on more complex cases as experience grows in the CABG group.](https://image.slidesharecdn.com/78b56fe4-ab4c-4ffe-bcd0-d611bf4ef6a1-170117170852/85/out-1-320.jpg)
