Abstract 12194: Rates of Selection of Revascularization Strategy (PCI versus CABG) Do Not Influence In-Hospital Mortality in Acute Coronary Syndromes (ACS).

Background: National trends in acute coronary syndrome (ACS) treatment strategy show increasing utilization of percutaneous coronary interventions (PCI) over coronary artery bypass graft (CABG). We evaluated whether the increased use of PCI in some hospitals results in high PCI:CABG ratios, leading to higher PCI or overall mortality due to aggressive case selection. Methodology: The National Inpatient Sample (NIS) for the year 2014 was queried. All patients (pts) admitted for ACS who received either CABG or PCI were selected. We identified the 100 hospitals with highest volume of either kind of revascularization. PCI:CABG ratio was calculated and overall and PCI mortality rate for each hospital collected. Pearson correlation coefficient was utilized to assess for linear correlation of mortality vs. ratio. Results: Out of 72,755 pts selected, 81.3% received PCI and 18.7% received CABG. Mean age was 63.6±12.4 years and 69.2% were women. Mean number of PCIs performed per hospital was 591.4±194.7 and for CABG was 136.2 ±70.7. The average PCI:CABG ratio per hospital was 5.18±2.55 (range 1.4-15.0). Mean PCI in-hospital mortality was 2.90±1.67% and for CABG was 3.32%±3.91% p=0.324. Combined mortality for either strategy was 2.97%±1.56%. There was no relationship between PCI:CABG ratio and overall mortality rate (r =.008, P=.940) or PCI related mortality (r= -.002, P=.984). Conclusions: Increased relative utilization of PCI versus CABG has had no deleterious impact on mortality in ACS. PCI vs CABG case selection in ACS does not appear to be useful as a quality indicator. [ABSTRACT FROM AUTHOR]