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Introduction: Spain is one of the countries with the lowest rates of
revascularization and highest ratio of percutaneous coronary intervention
(PCI) to coronary artery bypass grafting (CABG). Objectives: To
investigate the changes and trends in the two revascularization procedures
between 1998 and 2017 in our country. Design: Retrospective cohort study.
Analysis of in-hospital outcomes. Setting: Minimum Basic Dataset from the
Spanish National Department of Health: mandatory database collecting
information of patients who are attended in the Spanish public National
Health System. Participants: 603,976 patients who underwent isolated CABG
or PCI in the Spanish National Health System. The study period was divided
in four 5-year intervals. Patients with acute myocardial infarction on
admission were excluded. Primary and Secondary Outcomes: We investigated
the volume of procedures nationwide, the changes of the risk profile of
patients and in-hospital mortality of both techniques. Results: We
observed a 2.2-fold increase in the rate of any type of myocardial
revascularization/million inhabitants-year: 357 (1998) to 776 (2017).
93,682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2
(1998-2002) to 8.1 (2013-2017). Charlson´s index increased by 0.8 for CABG
and 1 for PCI. The median annual volume of PCI/hospital augmented from 136
to 232, while the volume of CABG was reduced from 137 to 74. In the two
decades, we detected a significant reduction of CABG in-hospital mortality
(6.5% Vs 2.6%, p<0.001) and a small increase in PCI (1.2% Vs 1.5%,
p<0.001). Risk adjusted mortality rate was reduced for both CABG
(1.51 Vs 0.48, p<0.001), and PCI (1.42 Vs. 1.05, p<0.001).
Conclusion: We detected a significant increase in the volume of
revascularizations (particularly PCI) in Spain. Risk-adjusted in-hospital
mortality was significantly reduced.
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